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1996-03-04
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Document 0580
DOCN M9640580
TI Pulmonary complications of HIV disease: 10 year retrospective evaluation
of yields from bronchoalveolar lavage, 1983-93.
DT 9604
AU Taylor IK; Coker RJ; Clarke J; Moss FM; Nieman R; Evans DJ; Veale D;
Shaw RJ; Robinson DS; Mitchell DM; Department of Respiratory Medicine,
St Mary's Hospital Medical; School, London, UK.
SO Thorax. 1995 Dec;50(12):1240-5. Unique Identifier : AIDSLINE
MED/96138474
AB BACKGROUND--Pulmonary disease is a major contributor to morbidity and
mortality in patients with HIV infection and AIDS. The aim of this study
was to describe bronchoscopic findings and the spectrum of pulmonary
pathogens in HIV seropositive patients undergoing investigation of
respiratory disease over a 10 year period in a major UK referral centre.
METHODS--Recruitment was procedure based with data being captured when
bronchoscopy was clinically indicated. Data were evaluated from 580 HIV
seropositive patients (559 men, age 13-65 years) over a 10 year period
from June 1983 to March 1993. RESULTS--A total of 947 bronchoscopies was
performed. The most frequent pulmonary pathogen isolated from
bronchoalveolar lavage (BAL) fluid in 44% of all bronchoscopies was
Pneumocystis carinii. Of all patients studied, 324 (55%) had at least
one cytologically confirmed episode of P carinii pneumonia; this was
AIDS defining in 219 (38%) of patients who underwent bronchoscopy.
Between 1987 and 1993 the overall diagnostic yield from BAL fluid was
76%; 25% of all bronchoscopies yielded positive microbiological results,
the most frequent isolates being Staphylococcus aureus, Streptococcus
pneumoniae, Pseudomonas spp, and Haemophilus influenzae. Mycobacteria
were identified in 8% of patients; M tuberculosis was the most common
being identified in 3% of lavage samples and in 4% of patients. No
drug-resistant M tuberculosis was found. Viral isolates (mainly
cytomegalovirus) were identified in up to 31% of BAL fluid samples.
Endobronchial Kaposi's sarcoma was seen in 15% of patients at
bronchoscopy. CONCLUSIONS--Of the 1956 newly diagnosed HIV seropositive
patients receiving clinical care at St Mary's Hospital over this period,
approximately 30% underwent bronchoscopy. Diagnostic rates for P carinii
pneumonia, endobronchial Kaposi's sarcoma, and bacterial and
mycobacterial infection have remained largely constant since 1989.
Bronchoalveolar lavage produces high diagnostic yields generally, and P
carinii pneumonia remains a common cause of pulmonary disease in these
patients.
DE Adolescence Adult Aged Bronchial Neoplasms/COMPLICATIONS
*Bronchoalveolar Lavage Fluid/MICROBIOLOGY Bronchoscopy
Cytomegalovirus Infections/COMPLICATIONS Female Haemophilus
Infections/COMPLICATIONS Human HIV Infections/*COMPLICATIONS Lung
Diseases/COMPLICATIONS/*MICROBIOLOGY Male Middle Age Pneumococcal
Infections/COMPLICATIONS Pneumonia, Pneumocystis carinii/COMPLICATIONS
Pneumonia, Staphylococcal/COMPLICATIONS Pseudomonas
Infections/COMPLICATIONS Retrospective Studies Sarcoma,
Kaposi's/COMPLICATIONS Tracheal Neoplasms/COMPLICATIONS Tuberculosis,
Pulmonary/COMPLICATIONS JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).