Microbial, Cytological, and Histopathological Analysis of Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Diagnosis of Community-acquired Pneumonia: A Prospective Study
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.
Marrie TJ. Acute Bronchitis and Community-Acquired Pneumonia. In: Grippi MA, Elias JA, Fishman JA, et al., Fishman's Pulmonary Diseases and Disorders, 5th edition; New York, NY: McGraw-Hill Education; 2015.
Mandell LA, Wunderink R. Pneumonia. In: Jameson JL, Fauci AS, Kasper DL, et al. Harrison's Principles of Internal Medicine, 20th edition; New York, NY: McGraw-Hill Education; 2018.
Bartlett JG. Diagnostic tests for agents of community-acquired pneumonia. Clin Infect Dis 2011;52(Suppl. 4):S296–S304. DOI: 10.1093/cid/cir045.
Arancibia F, Ewig S, Martinez JA, et al. Antimicrobial treatment failures in patients with community-acquired pneumonia: Causes and prognostic implications. Am J Respir Crit Care Med 2000;162(1): 154–160. DOI: 10.1164/ajrccm.162.1.9907023.
Kuru T, Lynch JP III. Nonresolving or slowly resolving pneumonia. Clin Chest Med 1999;20(3):623–651. DOI: 10.1016/s0272-5231(05) 70241-0.
White DA, Camus P, Endo M, et al. Noninfectious pneumonitis after everolimus therapy for advanced renal cell carcinoma. Am J Respir Crit Care Med 2010;182(3):396–403. DOI: 10.1164/rccm.200911-1720OC.
Kheir F, Hamdi T, Khayr W, et al. Nonresolving pneumonia. Am J Ther 2011;18(5):e177–e179. DOI: 10.1097/MJT.0b013e3181d10a93.
Feinsilver SH, Fein AM, Niederman MS, et al. Utility of fiberoptic bronchoscopy in nonresolving pneumonia. Chest 1990;98(6): 1322–1326. DOI: 10.1378/chest.98.6.1322.
Farooqui H, Jit M, Heymann DL, et al. Burden of severe pneumonia, pneumococcal pneumonia and pneumonia deaths in Indian states: Modelling based estimates. PLoS One 2015;10(6):e0129191. DOI: 10.1371/journal.pone.0129191.
Griffiths MH, Kocjan G, Miller RF, et al. Diagnosis of pulmonary disease in human immunodeficiency virus infection: Role of transbronchial biopsy and bronchoalveolar lavage. Thorax 1989;44(7):554–558. DOI: 10.1136/thx.44.7.554.
Malhotra RK, Indrayan A. A simple nomogram for sample size for estimating sensitivity and specificity of medical tests. Indian J Ophthalmol 2010;58(6):519–522. DOI: 10.4103/0301-4738.71699.
El-Shabrawy M, EL-Sokkary RH. Role of fiberoptic bronchoscopy and BAL in assessment of the patients with non-responding pneumonia. Egypt J Chest Dis Tuberc 2016;65(3):613–620. DOI: 10.1016/j.ejcdt.2015.12.006.
Kim ES, Kim EC, Lee SM, et al. Bacterial yield from quantitative cultures of bronchoalveolar lavage fluid in patients with pneumonia on antimicrobial therapy. Korean J Intern Med 2012;27(2):156–162. DOI: 10.3904/kjim.2012.27.2.156.
Chaudhuri AD, Mukherjee S, Nandi S, et al. A study on non-resolving pneumonia with special reference to role of fiberoptic bronchoscopy. Lung India 2013;30(1):27–32. DOI: 10.4103/0970-2113.106130.
Almirall J, Serra–Prat M, Bolíbar I, et al. Risk factors for community-acquired pneumonia in adults: A systematic review of observational studies. Respiration 2017;94(3):299–311. DOI: 10.1159/000479089.
