1. Clinical utility of bronchoalveolar lavage and respiratory tract biopsies in diagnosis and management of suspected invasive respiratory fungal infections in children.
- Author
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Batra S, Li B, Underhill N, Maloney R, Katz BZ, and Hijiya N
- Subjects
- Adolescent, Adult, Antifungal Agents therapeutic use, Biopsy adverse effects, Child, Child, Preschool, Disease Management, Drug Substitution, Female, Hematopoietic Stem Cell Transplantation, Humans, Immunocompromised Host, Infant, Lung Diseases, Fungal complications, Lung Diseases, Fungal diagnosis, Lung Diseases, Fungal drug therapy, Lung Diseases, Fungal pathology, Male, Mycoses complications, Mycoses drug therapy, Mycoses pathology, Neoplasms complications, Neoplasms therapy, Opportunistic Infections complications, Opportunistic Infections diagnosis, Opportunistic Infections pathology, Opportunistic Infections therapy, Pneumothorax epidemiology, Pneumothorax etiology, Respiratory Tract Infections complications, Respiratory Tract Infections drug therapy, Respiratory Tract Infections pathology, Retrospective Studies, Sinusitis complications, Sinusitis diagnosis, Sinusitis drug therapy, Sinusitis pathology, Tomography, X-Ray Computed, Young Adult, Biopsy statistics & numerical data, Bronchoalveolar Lavage Fluid microbiology, Mycoses diagnosis, Respiratory Tract Infections diagnosis
- Abstract
Background: Bronchoscopy with bronchoalveolar lavage (BAL) and respiratory tract biopsies are important tools for diagnosing fungal infections in children with cancer and hematopoietic stem cell transplant (HSCT) recipients. Our objective was to evaluate the impact of BAL and respiratory tract biopsies on the management of suspected fungal infections in oncology and HSCT patients., Procedure: We retrospectively reviewed the medical records of oncology and HSCT patients with possible, probable, or proven fungal infection of the respiratory tract and determined whether BAL or biopsy following computed tomography (CT) prompted a change in management., Results: Among 101 patients (0.5-29 years of age), 24 underwent a BAL and 31 had biopsies (27 lung and 4 sinus). The remaining 46 patients had CT scans only. Of these, there were radiographic findings suggestive of a fungal infection in 38 patients (83%). Thirty of these 38 patients (79%) had a change in management. BAL provided a diagnosis in 6 of 24 patients (25%). There was a change in management in 2 of the 6 (33%). Respiratory tract biopsy provided a diagnosis in 12 of 31 patients (39%). Biopsy results led to a change in management in 4 of the 12 patients (33%). Significant postoperative morbidity attributed to biopsy occurred in 3 of 31 patients (10%); 2 patients had pneumothorax requiring chest tube and intubation and a patient had prolonged intubation., Conclusion: BAL and biopsy in children with an oncological diagnosis or those undergoing HSCT only infrequently lead to changes in management in the era of empiric therapy with broad-spectrum anti-fungal agents., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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