cord-001280-skavefji	2014	This study investigated the ability of cellular analysis of BAL fluid to differentially diagnose bacterial pneumonia from viral pneumonia in adult patients who are admitted to intensive care unit. Exclusion criteria were as follows: (1) patients in whom the pathogen was not identified, (2) patients in whom BAL fluid analysis was impossible (due to severe neutropenia or clotting of specimen) or not performed, (3) patients with a mixed infection (identification of bacteria and virus), (4) patients who were treated with antimicrobial agents for more than 24 hours before bronchoscopic BAL, (5) patients with invasive pulmonary aspergillosis, (6) patients with mycobacterial infection, and (7) patients with Pneumocystis jirovecii pneumonia. Several authors of the current study previously investigated the diagnostic utility of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in BAL fluid of various patient populations with bilateral lung infiltrates.
cord-002823-n55xvwkf	2018	The effect of local elevation of GM-CSF on IAV infection in the lung has been investigated in transgenic models with expression of GM-CSF under the control of constitutive or doxycycline-inducible promoters in lungs of alveolar or small airway epithelial cells of GM-CSF knockout (csf2 −/− ) mice [3, 4] . To examine the mechanism of protection conferred by therapeutic GM-CSF levels, we measured respiratory and biochemical parameters of lower airway disease, and analyzed the transcriptome of FACS-sorted AMs and exudative macrophages (EM) from IAV-infected mice. IPA also predicted the activation of the IL-10 receptor alpha-chain in both AMs and EMs. Given that IL-10 levels in BAL fluid were not elevated in DTGM as compared WT mice (Additional file 6: Figure S4D ), it is possible that GM-CSF overexpressing during IAV somehow potentiates IL-10 signaling in the lung microenvironment.
cord-004002-b35wm2db	2019	BMI, body mass index; ICU, intensive care unit; ARDS, acute respiratory distress syndrome; SAPS2, simplified acute physiology score version 2; SOFA score, sequential organ failure assessment score; HIV, human immunodeficiency virus; PJP, Pneumocystis jirovecii pneumonia; CRP, C-reactive protein; LDH, lactate dehydrogenase; PJ, Pneumocystis jirovecii a The total exceeds 100% because some patients had more than one cause of immunodeficiency b Of these 21 patients, 7 followed their prescribed prophylactic regimen (aerosolised pentamidine, n = 6; and atovaquone, n = 1) and 14 did not (trimethoprim/sulfamethoxazole, n = 11; and aerosolised pentamidine, n = 3) Two factors were independently associated with 90-day mortality by multivariate analysis, a worse SOFA score was associated with higher 90-day mortality (OR, 1.05; 95% CI 1.02-1.09; p < 0.001), whereas BAL fluid alveolitis profile was associated with lower 90-day mortality (OR, 0.79; 95% CI 0.65-0.96; p < 0.05) ( Table 3) .
cord-005748-2rpiv4d9	2007	Therefore, the objective of this study was to assess outcomes in association with the implementation of de-escalation therapy in a well-defined group of patients [11] who had developed VAP as confirmed by two separate cultures, one quantitative tracheal aspirate and one bronchoalveolar lavage (BAL) sample, that both had to be positive. The microbiological information that the attending physicians used to de-escalate antibiotic therapy, to establish the appropriateness of the initial antibiotic regimen and to confirm the diagnosis of VAP, in patients with clinical suspicion for infection, was derived from quantitative tracheal aspirate or BAL. Percentages may not add up to 100 because of combination multi-drug regimens and isolates with more than one pathogen grown at significant concentration Table 3 Antibiotics initially prescribed and pathogens identified in the respiratory sample that guided de-escalation therapy decisions in 143 patients with ventilator-associated pneumonia in 18.9% and elective surgery in 23.1%.
cord-006000-ekwpkzqv	1999	We analyzed 25 BAL samples and clinical data of 4 patients who underwent lung transplantation and presented with recurrent episodes of eosinophilic alveolitis in BAL. We analyzed 25 BAL samples and clinical data of 4 patients who underwent lung transplantation and presented with recurrent episodes of eosinophilic alveolitis in BAL. All patients demonstrated a deterioration of clinical condition, lung function, and blood gas analysis during times of eosinophilia in BAL, compared to previous examinations. In conclusion, eosinophilic alveolitis may indicate acute rejection in patients after lung transplantation, if other causes of eosinophilia are excluded. In conclusion, eosinophilic alveolitis may indicate acute rejection in patients after lung transplantation, if other causes of eosinophilia are excluded. In this retrospective study, clinical data and differential cell counts from BAL samples of 37 lung transplant recipients, who had been treated at the University of Kiel until December 1996 and were available for follow-up investigation, were analyzed.
cord-006676-a21tdgns	2001	Interleukin-8 (IL-8) is considered as the major polymorphonuclear neutrophils (PMNs) chemoattractant cytokine in lung diseases such as asthma and adult respiratory distress syndrome (ARDS). The level of IL-8 mRNA, protein and myeloperoxidase present in the cells of the bronchioalveolar lavages (BALs) taken from the areas of known pneumonic consolidations on chest X-ray (infected lung) are compared with the BALs obtained from areas of no obvious infiltrate (non-infected lung). Therefore this study is designed to measure the site-specific increase in the level of IL-8 in the lung of patients with bacterial pneumonia as compared to that of the non-smoking control group. The level of IL-8 mRNA and protein present in the BAL obtained from subsegmental bronchi of experimental and control group of patients were determined by RT-PCR assay and enzyme immunoassay respectively. In this study we also determined the level of myeloperoxidase activity in the cells collected from 1 ml of BAL each from the infected and non-infected lung.
cord-010819-a0nbmx3l	2020	CONCLUSION: In the injured patient, high blood alcohol levels are associated with increased incidence of fibrinolysis shutdown. Further research is needed to assess whether the association with fibrinolysis is modified by the chronicity and type of alcohol consumed and whether anti-fibrinolytic therapy in intoxicated patients produces adverse effects. Fibrinolysis shutdown has previously been identified as the most common fibrinolytic phenotype following injury and is also associated with increased mortality compared to physiologic fibrinolysis, often due to multiple organ failure [15] [16] [17] and has most commonly been measured by thrombelastography (TEG), a viscoelastic assay that provides a comprehensive assessment of clot formation and clot remodeling and degradation. In vitro and in vivo studies have provided data that ethanol affects the fibrinolysis profile and studies in healthy human volunteers suggest that this decrease in fibrinolysis is secondary to Patients with a high BAL class had an increased incidence of fibrinolysis compared to those with no detectable blood alcohol and those with > 0-150 mg/ dL (0-1.5 g/L) circulating levels of PAI-1 [2, 26] .
cord-011159-k2kca8zl	2020	b Patient recruitment exceeded the 500 expected, because we anticipated a number of non-workable case report forms h More than one indication could be present for each BAL i Significantly higher than in the nasal high-flow oxygen therapy or non-invasive ventilation group (p < 0.001), and then in the invasive mechanical ventilation group (p = 0.001) j H0 indicates the time at which BAL has began k Experience in years in the specialty and in terms of number of BAL performed are detailed in Table S1 of the Online resource 1 l We defined the physician performing the BAL as an "experienced physician" when he/she was a pulmonologist or when he/she was an intensivist with the greatest experience (i.e., > 10 years in the specialty or > 50 BAL performed) 35-3.50 ]; p = 0.002) and the amount of BAL fluid (in ml) recovered handled as a linear predictor (OR 1.02 [1.01-1.03] per 1 ml increase; p < 0.01), were statistically significant predictors of a BAL fluid of good quality (Table S6 ).
cord-016732-mdyu69ca	2007	Immersi in un tappeto di macrofagi alveolari frammisti a pochi linfociti,si osservano due aggregati di cellule ipercromatiche con aspetti di atipia (Papanicolau,x100) Il lavaggio broncoalveolare nelle pneumopatie infiltrative diffuse Occasionalmente il BAL può essere utile nella diagnosi di linfoma polmonare rivelando la presenza di un aumentato numero di linfociti che opportunamente studiati rivelano aspetti neoplastici [11, 12] . Sedimento di BAL in soggetto esposto all''inalazione di metalli duri.Nel sedimento accanto ad alcuni macrofagi alveolari si osservano due gigantesche cellule giganti mononucleate con aspetti di cannibalismo (fagocitosi di cellule mononucleate) (May Grunwald Giemsa,x400) Il lavaggio broncoalveolare nelle pneumopatie infiltrative diffuse Alveolite emorragica È un reperto comune a diverse patologie (granulomatosi di Wegener, poliangite microscopica, sindrome di Goodpasture, emosiderosi polmonare idiopatica, connettiviti, reazioni da farmaci etc.) che può essere di entità tale da influenzare l''aspetto macroscopico del BAL (recupero francamente ematico) suggerendo la diagnosi ovvero essere diagnosticata anche in caso di sanguinamento occulto.
cord-016936-cl3kezes	2007	5. Controllo della eventuale emorragia con l''aspiratore e con il palloncino gonfiato Alterazioni patologiche non specifiche sono comuni nei campioni ottenuti da TBB in questi pazienti, ma se interpretati nel contesto di uno specifico assetto clinico e dei pattern HRCT, possono contribuire alla definizione di una diagnosi specifica (in particolare i quadri di polmonite intersitiziale cellulata associata o meno alla presenza di granulomi con eventuale presenza nell''in-Procedure diagnostiche invasive nelle malattie infiltrative diffuse del polmone filtrato infiammatorio di eosinofili, di organizzazione endoalveolare, di danno alveolare diffuso osservabili in diversi contesti: tossicità polmonare da farmaci (Fig. 5 ), soggetti con dermatomiosite/polimiosite o altre connettiviti o in pazienti trapiantati) [2, 34] .
cord-017123-g1m1y38x	2007	Facendo la media tra i diversi studi pubblicati e dalla nostra esperienza, i valori "normali" di riferimento usati nel nostro laboratorio, possibilmente scartando la prima aliquota del BALF sono i seguenti: • macrofagi: 85%-90% • linfociti: 8%-10% • neutrofili: 1%-4% • eosinofili: 0%-0,2% Riguardo al giudizio di una buona esecuzione del BAL, poiché la popolazione macrofagica è la preponderante, ed il macrofago è la vera cellula residente alveolare, solo la presenza di una Il lavaggio broncoalveolare (BAL) in età pediatrica discreta quota di macrofagi (almeno 10%-20%) nelle aliquote di BALF susseguenti la prima è la prova che il liquido di lavaggio ha effettivamente raggiunto il parenchima polmonare. Invece nei pazienti con sintomi respiratori ricorrenti (laringo e/o broncospasmi, tosse, infezioni broncopolmonari) di incerta origine e poco responsivi alle usuali terapie mediche, in cui si possa sospettare che in realtà alla base vi possa essere una misconosciuta malattia da reflusso gastro-esofageo con sintomi sovraesofagei, vi sono forti indicazioni ad eseguire un BAL, proprio per la ricerca dei lipofagi alveolari.
cord-256424-t3dtabi4	2012	Recently, the bacterial microbiota of patients with cystic fibrosis and ventilator-associated pneumonia (VAP) were studied using 16S rDNA gene amplification followed by clone libraries sequencing [9] [10] [11] . Bacterial microbiota as evaluated by 16S rDNA Molecular assays were positive for at least one bacterium for 129 out of 185 bronchoalveolar lavage (BAL) samples from patients with pneumonia as well as from 13 out of 25 from control individuals (p = 0.07). Fungal microbiota obtained from patients showed the presence of 22 different species belonging to 2 phyla (8 orders, 11 families and 12 genera) among which 6 phylotypes had not been previously identified in BAL fluids from pneumonia. Indeed, our study reveals that some pathogens that till now had been considered typical for ICU pneumonia, such as Pseudomonas aeruginosa and Streptococcus species, or viruses, such CMV and HSV, can be detected as commonly in controls as in patients (Fig. S1 and S2 ).
cord-257459-elzhww5a	2017	Previous work in a single feedlot showed moderate agreement between DNS and BAL culture results in calves for Pasteurellaceae (Pasteurella multocida, Mannheimia haemolytica sensu lato, and Histophilus somni) and mycoplasmata. Therefore, the objectives of our study were (1) to determine the outcome of bacterial culture results, isolation rates, and agreement for samples taken with DNS and nonendoscopic BAL with respect to Pasteurellaceae and Mycoplasma bovis. To determine the effect of a polymicrobial DNS culture result on the probability of a pure culture in the BAL sample in calves with BRD, 5 different general linear mixed models were constructed with M. To determine how the respiratory tract should be sampled to isolate the causative pathogens, a crosssectional study was performed to compare bacterial culture results and commensal overgrowth between DNS and BAL samples. One of the main findings in the study on preweaned calves is that isolation rates of respiratory bacterial pathogens in both DNS and BAL samples were lower in controls compared to cases.
cord-275757-zpblaa36	2020	These culture-based guidelines propose specimen-specific thresholds ranging from 10 4 CFU/ml for BAL specimens to 10 5 to 10 6 CFU/ml for endotracheal aspirates (ETA) and sputa to define clinically significant infection and minimize reporting of low-abundance, likely commensal organisms to reduce the use of potentially unnecessary antibiotics. The aim of this study was to conduct a practical analysis of a subset of those specimens comparing results reported using routine SOC methods to those obtained using the PN panel and to assess the potential impact of the PN panel results on antibiotic utilization in these patients. aeruginosa, 10 5 copies/ a Numbers in parentheses are the numbers of culture-negative results obtained for specimens from patients who received antibiotics with potential activity against the given bacterial target detected within 72 h preceding specimen collection.
cord-281418-mvgp6qfv	2010	The aim of this study was to assess the association among the presence of a respiratory virus detected by molecular assays in bronchoalveolar lavage (BAL) fluid, respiratory symptoms, and acute rejection in adult lung transplant recipients. Upper (nasopharyngeal swab) and lower (BAL) respiratory tract specimens from 77 lung transplant recipients enrolled in a cohort study and undergoing bronchoscopy with BAL and transbronchial biopsies were screened using 17 different polymerase chain reaction—based assays. The present investigation was specifically designed to assess the epidemiology of respiratory viruses in bronchoalveolar lavage (BAL) fluid from lung transplant recipients and to analyze the relationship between these viruses and the presence of acute graft rejection. Because BAL fluid specimens were collected for a variety of clinical conditions, we were able to analyze the association among symptoms, the diagnosis suspected by the physician in charge, and the subsequent presence of a proven upper and/ or lower respiratory tract viral infection.
cord-286346-h87vcmrd	2019	title: Use of Aspergillus fumigatus real-time PCR in bronchoalveolar lavage samples (BAL) for diagnosis of invasive aspergillosis, including azole-resistant cases, in high risk haematology patients: the need for a combined use with galactomannan fumigatus qPCR in BAL contributes to diagnosing IA, particularly if combined with GM and in patients receiving mould-active agents might allow detecting azole-resistant mutations in culture negative samples. The aim of the study is to evaluate the performance of a commercially available Aspergillus fumigatus real-time quantitative PCR (qPCR), alone and in combination with GM, in BAL samples form patients at high risk of IA, and with various radiological lesions, including those receiving mould active antifungals. The prevalence of positive and negative results of BAL GM and Aspergillus fumigatus qPCR in four different IA diagnostic categories, divided also into patients receiving and not mould active agents at the time of BAL, is reported as supplement in Table S1 .
cord-291286-diwigcy9	2011	title: Microbiology of Bronchoalveolar Lavage Fluid in Children With Acute Nonresponding or Recurrent Community-Acquired Pneumonia: Identification of Nontypeable Haemophilus influenzae as a Major Pathogen We conducted a retrospective study of CAP etiology in 2 groups of pediatric patients who underwent flexible bronchoscopy (FOB) with bronchoalveolar lavage (BAL); children with acute nonresponsive CAP (NR-CAP; n = 127) or recurrent CAP (Rec-CAP; n = 123). pneumoniae were mostly found with another bacterial pathogen in 26 (70.3%) of 37 and 12 (70.6%) of 17 cases, respectively ( Atypical microorganisms alone were detected significantly more often in patients with NR-CAP than in patients with Rec-CAP (Table 3) . Since then, studies involving children with CAP or LRT infection (using serological testing or TNA) have suggested a possible role for NTHi in pediatric pneumonia but have failed to define it as a significant pathogen [24] .
cord-291960-1is0rv6c	2019	OBJECTIVES: To date no definitive cut-off value for cytomegalovirus (CMV) DNA load in bronchoalveolar lavage (BAL) fluid specimens has been established to discriminate between CMV pneumonia and pulmonary CMV DNA shedding in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. METHODS: The current retrospective study is aimed at assessing the range of CMV DNA loads quantified in BAL fluid specimens from allo-HSCT patients with pneumonia in which different microorganisms were causally involved. CMV pneumonitis was deemed to be unlikely in these patients owing to one or more of the following: (i) lack of typical findings in CTs (in all episodes); (ii) negative BAL cytospin results (in 25 episodes); (iii) negative lung histopathology at autopsy (in Table 2 Pneumonia attributable etiology and microbiological findings in bronchoalveolar lavage fluid specimens. First, we confirmed previous observations 8 -10 indicating that detection of CMV DNA in BAL fluid specimens using highly-sensitive PCR assays is a very common finding in allo-HSCT patients with pneumonia, irrespective of the definitive etiological diagnosis.
cord-292772-xdic7rcy	2019	Bordetella bronchiseptica, Mycoplasma spp., and Pneumocystis carinii were identified by polymerase chain reaction testing, and Klebsiella pneumonia was cultured from the bronchoalveolar lavage fluid. canis in a suspected immunocompromised Cavalier King Charles Spaniel with concurrent pulmonary and urinary tract infections involving four different pathogens, and highlights the importance of the use of polymerase chain reaction testing to detect canine Pneumocystis spp. 1 In the veterinary literature, there are many published cases of confirmed canine pneumocystosis-most of which described cases of young to middle-age dogs with suspected immunodeficiency, with the Miniature Dachshund, and the Cavalier King Charles Spaniel (CKCS) breeds most commonly reported. This case report, in the authors'' opinion, highlights four points about the diagnosis and clinical presentation of dogs with Pneumocystis spp. Second, the detection of the fungal pathogen was achieved through PCR testing of a BAL sample which was negative with microscopic visualization for Pneumocystis spp.
cord-295718-nt2n9p5v	2019	title: Bronchoalveolar lavage to evaluate new pulmonary infiltrates in allogeneic hematopoietic stem cell transplant recipients: impact on antimicrobial optimization Bronchoscopy with targeted bronchoalveolar lavage (BAL) is often used in AHSCT patients with suspected lower respiratory tract infection (LRTI) to help guide management. Bronchoscopy with bronchoalveolar lavage (BAL) is an important diagnostic tool to evaluate AHSCT recipients with new pulmonary infiltrates or without clinical response to empiric therapy [1, 2] . This study aims to determine how Aspergillus galactomannan antigen (AGA) and multiplex PCR added to traditional BAL testing affects antimicrobial treatment in AHSCT recipients with new pulmonary infiltrates. BAL was positive for infectious etiologies in 63%, mostly with elevated AGA (17/54), followed by multiplex PCR (13/54), positive bacterial (8/54), fungal (4/54) and AFB culture (1/54). BAL remained necessary to detect coinfections, as 9/13 patients with a positive multiplex PCR also had a positive bacterial culture (n¼2) or elevated AGA (n¼7) ( Table I) .
cord-302403-kahi8cbc	2009	Before HAART, defined as a combination of medications that usually includes at least three potent anti-HIV agents, treatment largely consisted of specific opportunistic infection management and less effective antiretroviral therapy. In many parts of the world, the main causes of death in patients with HIV infection include bacterial pneumonia, tuberculosis, and PCP. Recent work has shown chronic obstructive pulmonary disease (COPD) and lung cancer occur more frequently among HIV-infected individuals compared with the general population. In addition to pulmonary tuberculosis, extrapulmonary disease occurs in a high proportion of HIV-infected individuals with low CD4 lymphocyte counts (<150 cells/mL). Hence, some centers advocate use of empirical therapy for HIV-infected patients who are seen with symptoms and chest radiographic and blood gas abnormalities typical of mild PCP, without the need for bronchoscopy. On the basis of current evidence, patients with CD4 counts >200 cells/mL have a low risk of HIV disease progression or death during 6 months of treatment for tuberculosis.
cord-306346-rft22vo8	2014	METHODS: Protein levels of antimicrobial peptides (SLPI, HNP 1–3, elafin, and LL‐37) and neutrophil chemokines (CXCL1/GRO‐α, CXCL2/GRO‐β, CXCL5/ENA‐78, CXCL6/GCP‐2, CXCL7/NAP‐2, and CXCL8/IL‐8) were determined in bronchoalveolar lavage (BAL) fluid of 10 asthmatics and 15 normal controls taken before, at day four during and 6 weeks post‐experimental infection. It has been hypothesized that human rhinovirus infections should increase levels of a-defensins in the airways [10] , as they lead to marked neutrophil infiltration and degranulation in the airways [11] which are associated with clinical severity of virus-induced asthma [5, 12] . To test this hypothesis and to clarify whether this possible induction is related to airway neutrophilia and the expression of CXC chemokines, we analysed the expression of neutrophil antimicrobial peptides and CXC chemokines in BAL fluid of subjects with RV-induced experimental asthma exacerbations. Four days after infection, BAL HNP 1-3 and elafin were significantly higher in asthmatics compared with controls Repeated-measures multivariate analysis showed significant differences only in asthmatic subjects.
cord-321393-ffulkqrf	2015	Since 2008, all patients undergo a dedicated pulmonary screening consisting of pulmonary function test (PFT), chest high-resolution computed tomography (HRCT), and bronchial alveolar lavage (BAL) before HCT. Pre-HCT screening with the combination of 3 modalities, reflecting different domains of respiratory status (function, structure, and microbial colonization), reveals important abnormalities in a substantial number of patients. In 2008, we implemented extensive pre-HCT lung screening, which includes pulmonary function test (PFT), chest high-resolution computed tomography (HRCT), and bronchial alveolar lavage (BAL) in all patients. Patient characteristics (age, gender, underlying disease), clinical symptoms, results of pulmonary screening tests, and occurrence of symptomatic lung disease after HCT was registered. Standard pre-HCT pulmonary screening is performed in the week before transplantation and consists of a PFT, HRCT scan, and BAL. Our study in 142 pediatric patients shows that pulmonary screening before HCT with PFT, HRCT, and BAL is feasible.
cord-325068-j1lfq60o	2003	The results of inoculation tests performed with HUH7 cells were also positive, revealing corona-like particles that were subsequently identified as coronavirus 229E by RT-PCR performed on both culture supernatant and BAL fluid specimens. However, respiratory symptoms only appeared after completion of antiviral treatment and improvement of skin eruptions, and both viral culture and PCR for VZV performed on BAL fluid specimens were negative. The prevalence of coronavirus pulmonary infections among immunocompromised patients is unknown, and it is probably largely underestimated in the absence of the routine performance of sensitive cell culture, RT-PCR, or electron microscopy on BAL fluid specimens. Thus, only 1 case of coronavirus-associated pneumonia was previously described in an immunocompromised patient following autologous bone marrow transplantation, with the diagnosis based on the presence of viral particles in BAL fluid specimens [22] .
cord-328918-nc0a77r6	2020	title: Citrullinated histone H3, a marker of extracellular trap formation, is increased in blood of stable asthma patients In the present study we have evaluated circulating H3cit in stable asthmatics and investigated its relationship with asthma severity, pulmonary function and selected blood and bronchoalveolar lavage (BAL) biomarkers. We have recently reported evidence of a prothrombotic state in asthma which is characterized by enhanced plasma thrombin formation, impaired clot lysis and platelet activation [13] , all of them related to the low-grade systemic inflammation [3] , endothelial injury [14] , elevated exacerbation rate [15] , and likely increased atherosclerotic risk [16, 17] . In the present study we have demonstrated that serum H3cit, a novel biomarker of ETs formation, is increased in stable asthma subjects. Asthma is characterized by increased circulating H3cit likely related to the enhanced lung ETs formation.
cord-332298-ig1j5z07	2020	In the last few years, the terminology has further evolved with the term equine asthma (EA) now being recommended to describe horses with chronic respiratory signs ranging in severity from mild to severe that were previously referred as inflammatory airway disease and recurrent airway obstruction, respectively (3) . The future development of new portable and sensitive devices for measuring the lung function of horses (forced oscillation or flow interruption techniques), or the discovery of blood biomarkers for EA would help not only to facilitate the diagnosis of mild and moderate forms of EA in clinical practice, but also to possibly identify new phenotypes for these conditions. Qualitative data were gathered through semi-structured focus group discussions designed to capture current practices and opinions relating to the diagnosis and treatment of lower airway inflammation, as well as familiarity with and views on the most recent ACVIM consensus statement (3), in which the term "mild-moderate equine asthma" was recommended.
cord-335359-4rcj75tc	2020	We report here the use of a diagnostic assay that utilizes a universal extraction method, broad spectrum PCR amplification and analysis via electrospray ionization mass spectrometry (PCR/ESI-MS) to detect and identify more than 200 pathogenic fungi directly from bronchoalveolar lavage (BAL) specimens in less than 8 hours. For the clinical performance, the PCR/ESI-MS method was applied to prospectively collected BAL specimens obtained from patients suspected of, or at high risk for, pulmonary fungal infections. All BAL samples were processed at the Johns Hopkins Hospital Microbiology Laboratory for the detection and identification of fungal pathogens using all standard of care reference tests including direct microscopic examination by calcofluor white staining, fungal culture, galactomannan (positive cutoff value: GMI 0.5), and direct fluorescent antibody (DFA) microscopic examination that is the only method used for the detection of Pneumocystis jirovecii.
cord-335709-pta3nzz9	2020	This study assessed the performance of the BioFire FilmArray Pneumonia Panel (PN panel) and Pneumonia Plus Panel (PNplus panel), an FDA-cleared sample-to-answer assay that enables the detection of viruses, atypical bacteria, bacteria, and antimicrobial resistance marker genes from lower respiratory tract specimens (sputum and bronchoalveolar lavage [BAL] fluid). Prospectively collected respiratory specimens (846 BAL and 836 sputum specimens) evaluated with the PN panel were also tested by quantitative reference culture and molecular methods for comparison. Dilutions of contrived BAL samples containing cultured bacterial isolates in a matrix of sterile physiological saline and 20 ng/l human genomic DNA were tested repeatedly with the PN panel (90 replicates) to assess both the linearity and accuracy of the test''s semiquantitative bin results. Validation testing demonstrated that most assays (at least one or both per analyte in both BAL and sputum sample types) had a limit of detection (LoD) that was within at least 5-fold that of the PN panel, which was considered "equivalent" sensitivity.
cord-337637-wehstffa	2007	Bronchoalveolar lavage (BAL; three aliquots of 1 ml/kg saline) was performed in the right middle lobe of 24 (11 atopic and 13 nonatopic) children with persistent cough (8 females, 16 males), mean age 4.7 years (range: 1–11). 1 Atopic patients with chronic cough due to cough variant asthma are thought to have airway inflammation similar to atopic patients with asthma, whose bronchoalveolar lavage (BAL) fluid contains eosinophils and mast cells. A nonsignificant increase in the number of total cells per ml of BAL fluid was observed in both atopic (median: 39 Â 10 4 , range: 20-123 Â 10 4 ) and nonatopic (median: 22 Â 10 4 , range: 17-132 Â 10 4 ) children with chronic cough when compared to controls (median: 11 Â 10 4 , range: 9-30 Â 10 4 ).
cord-340544-ce5ic04g	2017	PURPOSE: Stem cell transplant (SCT) recipients commonly undergo bronchoalveolar lavage (BAL) collection as an infectious pulmonary work‐up. Previous studies report the utility and overall diagnostic yield of fiberoptic bronchoscopy with BAL in this vulnerable population, though none focused purely on microbiologic yield or made comparisons with less invasive means of pathogen detection. We sought to determine and elaborate on the microbiologic yield of BAL in SCT recipients, assess a correlation between BAL studies and less invasive means of pathogen detection, and assess the utility of repeating a BAL within 30 days. RESULTS: Our study showed an overall BAL microbiologic yield of 40%, despite 92% of patients receiving broad‐spectrum antimicrobial therapy at the time of the BAL procedure. We therefore sought to determine and elaborate the overall microbiologic yield of BAL in recipients of autologous (auto-SCT) and allogeneic (allo-SCT) SCTs, who underwent an infectious pulmonary work-up at our institution.
cord-346411-d2re00r9	2020	In a small study of adults, the majority of which were HCT recipients or had a hematologic malignancy, with matched NP and BAL specimens, PCR-based NP testing for respiratory viruses in patients with clinical evidence of LRT disease had a high negative predictive value (NPV) and a lower positive predictive value (PPV) [5] . A larger study that included mostly immunocompromised patients concluded that if a pathogen (a respiratory virus or 1 of 3 bacterial pathogens detected by a multiplex PCR panel) was already identified from an NP sample, BAL testing is unlikely to provide additional information; however, a significant number (20%) of subjects had a pathogen detected in the BAL without a positive NP sample [6] . In the present study, we characterized the rates of discordance in respiratory viral detection between matched URT and LRT samples in a large cohort of HCT candidates/recipients who underwent BAL for suspected LRTI and had concomitant URT testing.
cord-352502-vdm55zvq	2020	Francesco Salton 1 , Pietro Geri 1 Deepak and Colleague misreported that BAL was negative for SARS-CoV-2 rRT-PCR in majority of cases, including 38 patients with "strong clinical and radiological suspicion for COVID-19". On the contrary, in the only 2 cases of our series in which CT scan showed typical signs of COVID-19 infection according to a recently published international consensus statement [2] , BAL was positive for SARS-CoV-2 despite previous negative upper respiratory tract swabs. Moreover, we reported that, when chest CT scan was normal, then both upper respiratory tract swabs and BAL were rRT-PCR-negative for SARS-CoV-2. These findings support our main observation that BAL is likely to be negative if one or more upper respiratory tract specimens and thoracic imaging are concordantly negative, therefore it should be only reserved for those cases in which a high clinical and radiological suspicion for COVID-19 stands despite negative upper respiratory tract swabs.
cord-353256-7nfklun9	2019	OBJECTIVES: To demonstrate the value of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) when determining causes of lung infection in immunocompromised children; to investigate differences in causes and radiological features of lung infections following bone marrow transplantation (BMT) compared to other immunosuppressive conditions; to evaluate the reliability of radiological findings when predicting the pathogen. The purpose of the study was to demonstrate the value of FB and BAL in determining the cause of lung infections that develop in immunocompromised children, to investigate differences between the causes and radiological features of lung infections following BMT in comparison to other immunosuppressive conditions and to evaluate the reliability of radiological findings for predicting the causative pathogen. When all of the patients were considered together, a significant association was determined between the presence of viral pathogens (including CMV) and the radiological findings of interstitial infiltration and/or a ground-glass appearance (P = .003).
cord-355623-tmr1ieg1	2020	Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in preschool children with no symptoms or signs of other specific causes, and resolution usually follows a 2-week course of an appropriate oral antibiotic. in an Australian study among children with a history of chronic wet cough lasting more than 4 weeks, a positive culture of a respiratory pathogen on BAL (bacterial growth ≥10 4 CFU/ml in BAL) obtained during a flexible bronchoscopy and a clinical response to 2 weeks treatment with antibiotics (amoxicillinclavulanate acid) (9) ( Table 1) . According to the European Respiratory Society (ERS) guidelines new definition, PBB-clinical is based on all three of the following criteria: "presence of chronic (>4 weeks'' duration) wet or productive cough; absence of symptoms or signs (i.e., specific cough pointers) suggestive of other causes of wet or productive Abbreviations: BA, bronchial aspirate; BAL, bronchoalveolar lavage; CLDS, cystic lung diseases; CT, computerized tomography; GER, gastroesophageal reflux; NTHi, Haemophilus influenzae non-typeable; PBB, protracted bacterial bronchitis; QoL, quality of life; UACS, upper airway cough syndrome.