Cáncer, neutropenia febril e imágenes pulmonares: Hallazgos en el lavado broncoalveolar en niños / Cancer, febrile neutropenia and pulmonary images: Findings in bronchoalveolar lavage in children

ABSTRACT

Introduction: Lung infections are a serious complication in children with cancer. Bronchoalveolar lavage (BAL) has been demonstrated to be an effective procedure for achieving etiologic diagnosis. Method: We did a retrospective analysis of BAL data performed between November 2005 and October 2008 in children with cancer, severe neutropenia and lung infiltrates for assessing its performance, clinical utility and safety. Thirty-seven BAL were evaluated in 35 patients. Results: Focal infiltrates were demonstrated in imaging studies associated with 19/37 BAL; in 8 an infectious agent was found. Interstitial pattern was observed in 15/37, in which there were 4 positive studies, proving a higher microbiological performance in BAL associated with focal lesions. BAL yielded significant microbiological findings in 32.4% (12/37). Sixteen microorganisms were identified in the study bacteria in 8 cases, Mycobacterium tuberculosis (n 2), Pseudomonas aeruginosa (n 2), Acinetobacter baumannii (n 1), A. Iwoffii (n 1), group viridans Streptococcus (n 1), Mycoplasma pneumoniae (n 1); viruses in 3 cases, metapneumovirus (n 2) cytomegalovirus (n 1) and fungal infection in 5 cases, Pneumocystis jiroveci (n 2) Aspergillus fumigatus (n 1), Aspergillus niger (n 1), Candida albicans (n 1). Therapeutic adjustments were done in 6/37 episodes (16.2%). Conclusion: BAL has a significant role in the evaluation of pulmonary infiltrates in pediatric oncological patients, requiring a prompt and safe diagnosis, which is crucial for the survival with minimal morbidity. Our results suggest that BAL by fiberbronchoscopy should be considered as an initial diagnostic tool in these patients.

RESUMEN

Las infecciones pulmonares en niños con cáncer son una complicación grave. El lavado broncoalveolar (LBA) es un procedimiento efectivo para llegar a un diagnóstico etiológico. Se analizaron los resultados de LBA realizados entre noviembre de 2005 y octubre de 2008, en niños con cáncer y neutropenia grave e infiltrados pulmonares para conocer su rendimiento, utilidad clínica y seguridad. Se evaluaron 37 LBA en 35 pacientes. En 19/37 casos los infiltrados radiológicos fueron focales, en 8 se encontró etiología por LBA. En 15/37 casos las imágenes fueron intersticiales encontrándose etiología en 4, resultando un rendimiento microbiológico superior en las lesiones focales. Las muestras del LBA fueron positivas en 32,4% de los episodios (12/37). Se detectaron 16 microorganismos 8 bacterias, a saber Mycobacterium tuberculosis (n 2), Pseudomonas aeruginosa (n 2), Acinetobacter baumannii (n 1), A. Iwoffii (n 1), Streptococcus grupo viridans (n 1) y Mycoplasma pneumoniae (n 1); 3 virus metapneumovirus (n 2) y citomegalovirus (n 1); 5 hongos Pneumocystis jiroveci (n 2), Aspergillus fumigatus (n 1), Aspergillus niger (n 1) y Candida albicans (n 1). Se reportaron cambios en la conducta terapéutica en 6 de 37 pacientes (16,2%) con inicio de nuevas terapias o suspensión de tratamientos empíricos. El LBA tuvo un adecuado rendimiento, sin complicaciones importantes por lo que debe ser considerado precozmente y realizado con un estudio protocolizado.