The last decade has witnessed the evolution of bronchoalveolar lavage (BAL) from an experimental procedure to a diagnostic tool with important clinical applications. Although BAL has become routine practice in identifying opportunistic infections in immunosuppressed patients, its importance in diagnosing nonopportunistic bacterial pneumonia has only recently emerged. The intent of this review is to summarize the findings of the literature in this field, to describe the laboratory processing provided at our center, and finally to conclude with suggestions for the use of BAL in diagnosing nonopportunistic pulmonary infections. buy birth control online
Pneumonia can be defined as the inflammatory response of the host to the uncontrolled multiplication of pathogenic organisms in the distal airways and alveoli of the lung. Pathogenic organisms can reach the lower airways by one of three routes: aspiration from the oropharynx, inhalation, and less frequently by hematogenous spread. To establish an etiologic diagnosis of pneumonia, physicians traditionally rely on the findings of microscopic and culture analysis of the sputum. This time-honored practice, however, has proven limitations. The oropharynx is normally colonized by a complex microbial flora containing organisms at a high concentration (106 cfu/ml) easily contaminating secretions expectorated from the lower respiratory tract.
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