2. Tuberculosis: Bronchoscopy has been advocated for obtaining lower airway secretions from patients with suspected tuberculosis when expectorated or induced sputa are either unrewarding or negative. Among bronchoscopic specimens, BAL has been shown to have the highest diagnostic yield and should be incorporated into the procedure. 3. Atypical Bacterial Pneumonia: In many cases, “atypical” agents […]
Recent studies in patients with VAP have shown that appropriate antimicrobial treatment improves outcome, and that decision-making based on clinical criteria and results of tracheal aspirate is frequently erroneous. In ventilated patients, bronchoscopy with collection of distal respiratory secretions by PSB and BAL is at present, despite its limitation, the most reliable method to establish […]
The following suggestions are derived from our own experience and from a critical review of the published literature, which is limited in part by the lack of uniformity in patients’ selection and laboratory processing. proventil inhaler 1/ Bacterial Pneumonia: Best results with BAL bacterial cultures are obtained when bronchoscopy is performed in patients not receiving […]
Chlamydia pneumoniae As a newly recognized disease agent, methods for the laboratory diagnosis of C pneumoniae (previously strain TWAR) infections have not been clearly established. Although the diagnosis can be made serologically and by isolation from respiratory samples in cell culture, specific confirmation reagents are not yet commercially available. Nevertheless, we have recovered isolates of […]
Legionellosis The laboratory diagnosis of legionellosis is based on cultural isolation of the organisms, serologic conversion, and direct detection by fluorescent antibody techniques or DNA probes. Cultural isolation of the organism provides definitive diagnosis and has been successfully performed with BAL specimens. Isolation, however, may be somewhat problematic since the saline solution used for lavage […]
It can be easily combined with rapid identification methods such as DNA probes to diagnose tuberculosis earlier in patients. The use of alternative methods for direct nonculture-dependent detection of mycobacterial components such as nucleic acid hybridization, immunoassay for antigens, antibodies, or other markers has not as yet been applied to BAL samples in a routine […]
We employ the latter, with final dilution factors of 10_l,10, and 10-5 (Fig 2), similar to the method used for quantitative PSB cultures. Contaminants generally grow at a concentration ^lO cfu/ml and pathogens at a concentration ^lO cfu/ml, frequently ^lO.-* In practice, the quantitative method at one dilution (10 ~ dilution) obtained by plating 0.001 […]
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