Source: Annual Congress 2006 - Pneumonia and other invasive pulmonary infections in children
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

BAL in immunocompromised (IC) pts is established for pathogen detection, but potentially risky, with variable diagnostic yield and undefined outcome benefit. No paediatric studies using modern microbiological methods are available. We reviewed BAL-procedures at our hospital in IC children from 1997 to 2005 including risk and diagnostic yield.
Setting: Bronchoscopy department at a university childrens hospital.
Patients: Of 390 BAL in total, 35 were performed in IC children (4 mths - 18 yrs). Underlying disease: oncologic (n=11); hematologic stem cell transplant (HSCT) (n=7); solid organ transplant (n=4); immunodeficiency (n=13). BAL indications were new and persistent lung infiltrates despite standard treatment and failed/retarded noninvasive pathogen identification.
Methods: 4x1 ml/kg saline BAL during flexible bronchoscopy under anaesthesia. An extensive search for bacteria, viruses and fungi was performed by culture, antigen and PCR techniques.
Results: BAL was positive in 49% of pts. Highest and lowest diagnostic yield were obtained in post-HSCT (57%) and post solid organ transplant pts (25%) resp. In no case bacteria were identified; pneumocystis was exclusively found in primary immunodeficiency. Viral pathogens were Adeno, CMV, EBV and RSV. No severe adverse effects were encountered.
Conclusions: Pathogens can be identified by BAL in about 50% of IC children with new and persistent lung infiltrates. This compares well with recent adult data (Jain) and shows significant improvement over previous paediatric data (Stokes). The incremental value of BAL vs. non-invasive methods should be studied in a prospective design.
_{Jain P et al. Chest 2004; 125:712
Stokes DC et al. J Pediatr 1989;115:561}.

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Citations should be made in the following way:
K. Reiter, T. Nicolai (Munich, Germany). Bronchoalveolar lavage (BAL) in immunocompromised children: 8 years single center experience. Eur Respir J 2006; 28: Suppl. 50, 1781

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