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 Chlamydia species using procedures for the recovery of C trachomatis and confirmation with anti-LPS, genus-reactive fluorescent antibody reagents in approximately 2 percent of all BAL samples (unpublished personal experience). Nonculture dependent alternatives developed for detecting C trachomatis in urogenital samples, including enzyme immunoassay and direct fluorescent antibody stains, have also been successfully used for sputum specimens but not evaluated with BAL samples. Availability of methods for diagnosing C pneumoniae infection is important, and the value of BAL analysis should be established.
The treatment of bacterial infections of the lower respiratory tract is remarkably simplified when the responsible pathogen is accurately defined, allowing institution of the most effective and narrow spectrum antibiotic therapy. Microscopic analysis and quantitative bacterial cultures of the BAL fluid are a new diagnostic armamentarium in the hands of the clinician that, in selective situations, may provide useful information for treating patients with pneumonia.
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