Citation Information :
Soni N, Khadke V, Kulkarni V, Bahulikar A, Phalgune D. Microbial, Cytological, and Histopathological Analysis of Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Diagnosis of Community-acquired Pneumonia: A Prospective Study. Indian J Chest Dis Allied Sci 2023; 65 (2):69-73.
Background: In India, the incidence of community-acquired pneumonia (CAP) is 4 million cases per year, with 20% requiring hospitalization. A causative agent may not be isolated in about half of the cases despite careful testing. There is a paucity of data regarding the role of bronchoscopy with bronchoalveolar lavage (BAL) coupled with transbronchial lung biopsy (TBLB) in the diagnosis of CAP in the Indian population. This research aimed to evaluate the microbial, cytological, and histopathological analysis of BAL and TBLB in the diagnosis of CAP.
Materials and methods: This prospective observational study was conducted on 54 patients aged above or equal to 18 years of either sex who presented as CAP and were either immunocompromised, had non-responding pneumonia, or had radiology suggestive of atypical involvement of the lung. The BAL and TBLB with relevant microbiological, cytological, and histopathological investigations were carried out. The primary objective was to find the diagnostic yield of BAL and TBLB in patients presenting with CAP. The statistical agreement between the two diagnostic methods was tested using the Cohen–kappa technique. The sensitivity and specificity were calculated using the appropriate gold standard.
Results: The diagnostic yield was 75.9% on BAL, 94.4% on TBLB, and 100% with combined use of both BAL and TBLB. The sensitivity of BAL and TBLB was 91.1 and 88.9%, respectively, in the diagnosis of CAP. Forty-three (79.6%) patients showed infective pathogens, such as Pseudomonas aeruginosa (18.5%), Klebsiella pneumoniae (16.6%), Mycobacterium tuberculosis (18.5%); 9 patients (16.6%) were having non-infective etiology; while 2 patients (3.7%) were having combined etiology (infective + non-infective). Rare causes such as Mucormycosis 2 (3.7%), Nocardia 3 (5.6%), Pneumocystis jiroveci pneumonia (PJP) 2 (3.7%), and Aspergillosis 4 (7.4) which presented as necrotizing pneumonia were also identified.
Conclusion: Bronchoalveolar lavage and TBLB have a good diagnostic yield in patients presenting as CAP.
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