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 (eg, Legionella and Mycoplasma) may be detected in noninvasive samples such as pharyngeal swabs or sputum. Since these agents are rarely carried in asymptomatic persons, isolation from these sources implies a cause in a lower respiratory tract infection. Nevertheless, in critically ill and immunosuppressed patients with pneumonia of unknown cause and undergoing diagnostic bronchoscopy, it would seem prudent to perform tests in the BAL for all possible causal agents, including atypical bacteria.
Bronchoalveolar lavage is a simple and relatively safe bronchoscopic technique that has received widespread application in the diagnosis of opportunistic pulmonary infections. A substantial amount of work has been presented, indicating an emerging role for BAL in the examination of patients with suspected nonopportunistic bacterial pneumonia. Additional studies are required, however, to define better the diagnostic value of bacteriologic analysis of the BAL in various clinical settings. Interpretation of BAL fluid findings has been simplified for other respiratory disorders through a standard approach to BAL analysis and patient selection. A similar effort and collaboration in the field of respiratory infections are desirable to obtain more meaningful results that can be readily applied to the care of patients.
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