# ent

id: cord-275757-zpblaa36
type: ORG
entity:
  the BioFire FilmArray Pneumonia Panel to Routine Diagnostic Methods and Potential Impact on Antimicrobial Stewardship


id: cord-286346-h87vcmrd
type: ORG
entity:
  the European Organization for Research and Treatment of Cancer Invasive Fungal Infections Cooperative Group


id: cord-286346-h87vcmrd
type: DISEASE
entity:
  pneumocystosis Mycobacterium tuberculosis cytomegalovirus herpes simplex virus and respiratory viruses influenza parainfluenza respiratory syncytial virus metapneumovirus enterovirus rhinovirus coronavirus


id: cord-292772-xdic7rcy
type: PROTEIN
entity:
  cord 292772 xdic7rcy authors Petini Matteo Furlanello Tommaso Danesi Patrizia Zoia Andrea title Nested polymerase chain


id: cord-353256-7nfklun9
type: PROTEIN
entity:
  Haemophilus influenzae 10 1 Haemophilus haemolyticus 9 Enterococcus faecium 1 Pneumocystis jiroveci 1 Aspergillus species 2 1 Cytomegalovirus 5 5 16 and 117 children 17 with immunodeficiency In


id: cord-352502-vdm55zvq
type: ORG
entity:
  the Society of Thoracic Radiology the American College of Radiology and RSNA Radiol Cardiothorac Imaging False Negative Tests for SARS CoV 2 Infection Challenges and Implications


id: cord-016732-mdyu69ca
type: CHEMICAL
entity:
  l entità della linfocitosi né la percentuale di attivazione di queste cellule hanno valore prognostico o possono orientare il trattamento 1 4 19 Il lavaggio broncoalveolare nelle


id: cord-016732-mdyu69ca
type: CHEMICAL
entity:
  riscontrate concentrazioni aumentate di radicali tossici dell ossigeno proteasi e citochine TNF alpha IL 1 e 8 Nei pazienti ricoverati


id: cord-017123-g1m1y38x
type: DNA
entity:
  specifici marcatori genici 27 Riguardo a tutti questi studi di microbiologia per una corretta valutazione dei risultati bisogna comunque sempre tener presenti queste


id: cord-017123-g1m1y38x
type: WORK_OF_ART
entity:
  le ife fungine che le inclusioni intracellulari caratteristiche del Pneumocystis carinii Con la colorazione


id: cord-017123-g1m1y38x
type: CHEMICAL
entity:
  di normale aspetto radiologico è consigliabile eseguire la metodica prima nella zona di parenchima sano


id: cord-295718-nt2n9p5v
type: PROTEIN
entity:
  cord 295718 nt2n9p5v authors Vissichelli N C Miller K McCarty J M Roberts C H Stevens M P De La Cruz O title Bronchoalveolar


id: cord-295718-nt2n9p5v
type: CELL_LINE
entity:
  positive BAL bacterial culture OR 7 61 P 0 017 Antibiotic de escalation was more likely with an elevated AGA OR 3 86 P 0 035 Antiviral


id: cord-295718-nt2n9p5v
type: CELL_LINE
entity:
  positive BAL bacterial culture OR 7 61 P¼0 017 Table II Antibiotic de escalation was more likely with an elevated AGA OR 3 86 P¼0 035 Table II Antiviral


id: cord-291960-1is0rv6c
type: CELL_LINE
entity:
  BCYE alpha agar BD becston Dickinson MGIT Mycobacteria Growth Indicator Tube Lowenstein Jensen agar slants


id: cord-006676-a21tdgns
type: GGP
entity:
  myeloperoxidase muraminidase cathepsin A D E G 5 nucleotidase β galactosidase elastase collagenase azurocidin


id: cord-006676-a21tdgns
type: GGP
entity:
  HNP 3 arylsulfatase α mannosidase N acetyl β glucosaminidase β glucuronidase acid β glycerophosphatase


id: cord-016936-cl3kezes
type: DNA
entity:
  nuovi concetti patogenetici 73 74 75 Tabella 2 I punti chiave delle procedure broncoscopiche nelle pneumopatie


id: cord-016936-cl3kezes
type: GGP
entity:
  Gaucher s disease A case report Hermansky Pudlak syndrome and interstitial lung disease report of a case with lavage findings Transbronchoscopic lung biopsy


id: cord-016936-cl3kezes
type: CHEMICAL
entity:
  di infezioni opportunistiche proteinosi alveolari emorragia alveolare e capillariti infiltrazione polmonare leucemica Fig 1 o linfomatosa linfangite carcinomatosa metastasi polmonari ematogene


id: cord-016936-cl3kezes
type: CHEMICAL
entity:
  Nella Tabella 2 sono riportati i punti che riassumono il ruolo del BAL e della biopsia polmonare transbronchiale


id: cord-016936-cl3kezes
type: CHEMICAL
entity:
  granulomi nonnecrotizzanti polmonite interstiziale cellulata bronchiolite respiratoria etc La dimensione


id: cord-002823-n55xvwkf
type: PROTEIN
entity:
  interferon regulatory factor 3 IRF3 IRF7 interferon gamma IFNG interferon alpha beta receptor IFNAR TIR domain


id: cord-002823-n55xvwkf
type: ORG
entity:
  Laboratory Animals National Research Council US Committee for the Update of the Guide for the Care and Use of Laboratory Animals


id: cord-346411-d2re00r9
type: DNA
entity:
  HMPV 9 positive pairs 33 N P and 11 P N HRV 44 positive pairs 7 N P and 27 P N PIV2 2 positive pairs 50 N P and


id: cord-346411-d2re00r9
type: FAC
entity:
  the Upper Respiratory Tract for Infection of the Lower Respiratory Tract With Hematopoietic Stem Cell Transplantation


id: cord-256424-t3dtabi4
type: DISEASE
entity:
  Pseudomonas aeruginosa Streptococcus mitis Prevotella melaninogenica Peptostreptococcus stomatis Candida albicans


id: cord-256424-t3dtabi4
type: DISEASE
entity:
  Cytomegalovirus herpes simplex virus parainfluenza viruses types 1 and 3 respiratory syncytial virus varicella zoster


# bib

id: cord-001280-skavefji
author: Choi, Sang-Ho
date: 2014-05-13
txt: ./txt/cord-001280-skavefji.txt
cache: ./cache/cord-001280-skavefji.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019586/
doi: 10.1371/journal.pone.0097346
summary:
  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.

title:
  Usefulness of Cellular Analysis of Bronchoalveolar Lavage Fluid for Predicting the Etiology of Pneumonia in Critically Ill Patients

abstract:
  BACKGROUND: The usefulness of bronchoalveolar lavage (BAL) fluid cellular analysis in pneumonia has not been adequately evaluated. 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. METHODS: BAL fluid cellular analysis was evaluated in 47 adult patients who underwent bronchoscopic BAL following less than 24 hours of antimicrobial agent exposure. The abilities of BAL fluid total white blood cell (WBC) counts and differential cell counts to differentiate between bacterial and viral pneumonia were evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Bacterial pneumonia (n = 24) and viral pneumonia (n = 23) were frequently associated with neutrophilic pleocytosis in BAL fluid. BAL fluid median total WBC count (2,815/µL vs. 300/µL, P<0.001) and percentage of neutrophils (80.5% vs. 54.0%, P = 0.02) were significantly higher in the bacterial pneumonia group than in the viral pneumonia group. In ROC curve analysis, BAL fluid total WBC count showed the best discrimination, with an area under the curve of 0.855 (95% CI, 0.750–0.960). BAL fluid total WBC count ≥510/µL had a sensitivity of 83.3%, specificity of 78.3%, positive likelihood ratio (PLR) of 3.83, and negative likelihood ratio (NLR) of 0.21. When analyzed in combination with serum procalcitonin or C-reactive protein, sensitivity was 95.8%, specificity was 95.7%, PLR was 8.63, and NLR was 0.07. BAL fluid total WBC count ≥510/µL was an independent predictor of bacterial pneumonia with an adjusted odds ratio of 13.5 in multiple logistic regression analysis. CONCLUSIONS: Cellular analysis of BAL fluid can aid early differential diagnosis of bacterial pneumonia from viral pneumonia in critically ill patients.


id: cord-002823-n55xvwkf
author: Halstead, E. Scott
date: 2018-01-05
txt: ./txt/cord-002823-n55xvwkf.txt
cache: ./cache/cord-002823-n55xvwkf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756339/
doi: 10.1186/s12931-017-0708-5
summary:
  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.

title:
  GM-CSF overexpression after influenza a virus infection prevents mortality and moderates M1-like airway monocyte/macrophage polarization

abstract:
  BACKGROUND: Influenza A viruses cause life-threatening pneumonia and lung injury in the lower respiratory tract. Application of high GM-CSF levels prior to infection has been shown to reduce morbidity and mortality from pathogenic influenza infection in mice, but the mechanisms of protection and treatment efficacy have not been established. METHODS: Mice were infected intranasally with influenza A virus (PR8 strain). Supra-physiologic levels of GM-CSF were induced in the airways using the double transgenic GM-CSF (DTGM) or littermate control mice starting on 3 days post-infection (dpi). Assessment of respiratory mechanical parameters was performed using the flexiVent rodent ventilator. RNA sequence analysis was performed on FACS-sorted airway macrophage subsets at 8 dpi. RESULTS: Supra-physiologic levels of GM-CSF conferred a survival benefit, arrested the deterioration of lung mechanics, and reduced the abundance of protein exudates in bronchoalveolar (BAL) fluid to near baseline levels. Transcriptome analysis, and subsequent validation ELISA assays, revealed that excess GM-CSF re-directs macrophages from an “M1-like” to a more “M2-like” activation state as revealed by alterations in the ratios of CXCL9 and CCL17 in BAL fluid, respectively. Ingenuity pathway analysis predicted that GM-CSF surplus during IAV infection elicits expression of anti-inflammatory mediators and moderates M1 macrophage pro-inflammatory signaling by Type II interferon (IFN-γ). CONCLUSIONS: Our data indicate that application of high levels of GM-CSF in the lung after influenza A virus infection alters pathogenic “M1-like” macrophage inflammation. These results indicate a possible therapeutic strategy for respiratory virus-associated pneumonia and acute lung injury. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12931-017-0708-5) contains supplementary material, which is available to authorized users.


id: cord-004002-b35wm2db
author: Gaborit, Benjamin Jean
date: 2019-11-27
txt: ./txt/cord-004002-b35wm2db.txt
cache: ./cache/cord-004002-b35wm2db.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881486/
doi: 10.1186/s13613-019-0604-x
summary:
  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) .

title:
  Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study

abstract:
  BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) remains a severe disease associated with high rates of invasive mechanical ventilation (MV) and mortality. The objectives of this study were to assess early risk factors for severe PJP and 90-day mortality, including the broncho-alveolar lavage fluid cytology profiles at diagnosis. METHODS: We prospectively enrolled all patients meeting pre-defined diagnostic criteria for PJP admitted at Nantes university hospital, France, from January 2012 to January 2017. Diagnostic criteria for PJP were typical clinical features with microbiological confirmation of P. jirovecii cysts by direct examination or a positive specific quantitative real-time polymerase chain reaction (PCR) assay. Severe PJP was defined as hypoxemic acute respiratory failure requiring high-flow nasal oxygen with at least 50% FiO(2), non-invasive ventilation, or MV. RESULTS: Of 2446 respiratory samples investigated during the study period, 514 from 430 patients were positive for P. jirovecii. Of these 430 patients, 107 met criteria for PJP and were included in the study, 53 (49.5%) patients had severe PJP, including 30 who required MV. All patients were immunocompromised with haematological malignancy ranking first (n = 37, 35%), followed by solid organ transplantation (n = 27, 25%), HIV-infection (n = 21, 20%), systemic diseases (n = 13, 12%), solid tumors (n = 12, 11%) and primary immunodeficiency (n = 6, 8%). By multivariate analysis, factors independently associated with severity were older age (OR, 3.36; 95% CI 1.4–8.5; p < 0.05), a P. jirovecii microscopy-positive result from bronchoalveolar lavage (BAL) (OR, 1.3; 95% CI 1.54–9.3; p < 0.05); and absence of a BAL fluid alveolitis profile (OR, 3.2; 95% CI 1.27–8.8; p < 0.04). The 90-day mortality rate was 27%, increasing to 50% in the severe PJP group. Factors independently associated with 90-day mortality were worse SOFA score on day 1 (OR, 1.05; 95% CI 1.02–1.09; p < 0.001) whereas alveolitis at BAL was protective (OR, 0.79; 95% CI 0.65–0.96; p < 0.05). In the subgroup of HIV-negative patients, similar findings were obtained, then viral co-infection were independently associated with higher 90-day mortality (OR, 1.25; 95% CI 1.02–1.55; p < 0.05). CONCLUSIONS: Older age and P. jirovecii oocysts at microscopic examination of BAL were independently associated with severe PJP. Both initial PJP severity as evaluated by the SOFA score and viral co-infection predicted 90-day mortality. Alveolitis at BAL examination was associated with less severe PJP. The pathophysiological mechanism underlying this observation deserves further investigation.


id: cord-005748-2rpiv4d9
author: Giantsou, Elpis
date: 2007-06-05
txt: ./txt/cord-005748-2rpiv4d9.txt
cache: ./cache/cord-005748-2rpiv4d9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095354/
doi: 10.1007/s00134-007-0619-x
summary:
  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%.

title:
  De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate

abstract:
  OBJECTIVE: To assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study. SETTING: Multidisciplinary intensive care unit. PATIENTS AND PARTICIPANTS: VAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bronchoalveolar lavage (BAL) and treated appropriately for all significant isolates of tracheal aspirate and BAL in 143 patients who were assigned to de-escalation therapy by BAL or tracheal aspirate. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Antibiotic therapy was de-escalated in 58 patients (40.5%), who had decreased mortality at day 15 (5.1% vs. 31.7%) and day 28 (12% vs. 43.5%) and shorter intensive care unit (17.2 ± 1.2 vs. 22.7 ± 6.3 days) and hospital (23.7 ± 2.8 vs. 29.8 ± 11.1 days) stay (p < 0.05). Of the 81 patients assigned to tracheal aspirate, the 17 (21%) who achieved de-escalation of therapy had reduced 15-day mortality (5.8% vs. 34.3%), reduced 28-day mortality (11.6% vs. 45.3%), and shorter intensive care unit (17.2 ± 1.6 vs. 22.4 ± 6.4 days) and hospital (23.1 ± 4.4 vs. 29.9 ± 11.1 days) stay (p < 0.05). Of the 62 patients assigned to BAL, the 41 (66.1%) who achieved de-escalation of therapy had decreased 15-day mortality (4.8% vs. 23.8%), decreased 28-day mortality (12.1% vs. 38%), and shorter intensive care unit (17.2 ± 1.1 vs. 23.2 ± 6 days) and hospital (23.8 ± 2.4 vs. 29.8 ± 11.4 days) stay (p < 0.05). CONCLUSIONS: For patients with VAP who have had appropriate treatment and shown a favorable clinical response, mortality and duration of stay can be further improved by de-escalation therapy.


id: cord-006000-ekwpkzqv
title: Eosinophilic alveolitis in BAL after lung transplantation
author: Bewig, B.
date: 1999
txt: ./txt/cord-006000-ekwpkzqv.txt
cache: ./cache/cord-006000-ekwpkzqv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096104/
doi: 10.1007/s001470050221
summary:
  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.

abstract:
  Lung transplantation has become a therapeutic option for patients with end stage lung disease. However, outcome after transplantation is complicated by episodes of rejection and infections. Bronchoalveolar lavage is a valuable tool in monitoring patients after transplantation, since it allows the detection of pathogens. A marker specifically indicating rejection from changes in BAL fluid has not been found yet. Especially changes in differential cell count, like lymphocytosis or an increase in polymorphnuclear granulocytes, are unspecific. The role of high eosinophil levels in BAL has not been elucidated yet. 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 all cases, eosinophilia in BAL was accompanied by rejection. All patients were finally treated with high doses of steroids, resulting in improvement of all parameters. Eosinophilia was not associated with significant changes in the IL-5 concentration in BAL or the pattern of IL-5 expression in BAL cells. In conclusion, eosinophilic alveolitis may indicate acute rejection in patients after lung transplantation, if other causes of eosinophilia are excluded.


id: cord-006676-a21tdgns
title: Levels of IL-8 and myeloperoxidase in the lungs of pneumonia patients
author: Abul, H.
date: 2001
txt: ./txt/cord-006676-a21tdgns.txt
cache: ./cache/cord-006676-a21tdgns.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102223/
doi: 10.1023/a:1007264411006
summary:
  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.

abstract:
  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). However, controversial results were obtained regarding the involvement of IL-8 in the pathogenesis of pneumonia. This study examines the role of IL-8 in the recruitment and activation of PMNs in the lung of pneumonia patients. The interesting aspect of this study is that it is a site- specific analysis of the infected and uninfected lungs of the same patient. 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). The results obtained from the infected and non-infected lungs of pneumonic patients were further compared with that of a control group of non-smoking patients. The level of IL-8 mRNA and protein were determined by RT-PCR and ELISA respectively. There was a significant increase in the level of IL-8 mRNA in the infected lung as compared to its level in the non-infected lung (p < 0.001). In correlation with the increase in mRNA, IL-8 protein concentrations in BAL fluids from the infected lung were 6 fold higher than those taken from the non-infected lung (p < 0.0001). This pattern was also consistent with MPO activity in the BALs (4.5 fold more MPO activity in the infected lung as compared to that of the non-infected lung), indicating that IL-8 is directly implicated in neutrophil accumulation that follows acute respiratory infection. The results of the present study, therefore, indicate the involvement of IL-8 in the pathogenesis of pneumonia.


id: cord-010819-a0nbmx3l
title: Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients
author: Stettler, Gregory R.
date: 2020-03-10
txt: ./txt/cord-010819-a0nbmx3l.txt
cache: ./cache/cord-010819-a0nbmx3l.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222146/
doi: 10.1007/s00068-020-01328-x
summary:
  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] .

abstract:
  INTRODUCTION: High alcohol consumption has been associated with decreased fibrinolysis and enhanced thrombosis risk in cardiovascular disease. In trauma, alcohol has been associated with poor clot formation; however, its effect on fibrinolysis has not been fully investigated. We assessed the association of blood alcohol levels and fibrinolysis in trauma activation patients. METHODS: We queried our prospective registry of trauma activations from 2014 to 2016. Associations between viscoelastic measurements [rapid thrombelastography (rTEG)] and blood alcohol level (BAL) were determined and adjusted for confounders by a multinomial logistic regression. Lysis phenotypes were defined by the % lysis in 30 min (LY30) as follows: hyperfibrinolysis ≥ 3%, physiologic 0.9–2.9%, and fibrinolysis shutdown < 0.9%. RESULTS: Overall, 191 (43.8%) had BAL measured. There were 65 (34%) patients that had no detectable BAL, 32 (16.8%) had BAL of 10–150 mg/dL, and 94 (49.2%) patients had BAL > 150 mg/dL. BAL had a moderate, but significant inverse correlation with LY30 (Rho = − 0.315, p < 0.001), while there were no significant correlations between BAL and other TEG values. The distribution of fibrinolysis phenotypes varied significantly by BAL levels (p < 0.009, with high BAL having more shutdown and less hyperfibrinolysis than the other two BAL level groups. Multinomial logistic regression showed that after adjustment for confounders, BAL levels > 150 mg/dL were independently associated with a threefold increase in the odds of shutdown compared to undetectable BAL (OR 3.37, 95% CI 1.04–8.05, p = 0.006). High BAL was also significantly associated with higher odds of shutdown compared to low BAL (OR 2.63, 95% CI 1.15–6.06). Compared to physiologic fibrinolysis, fibrinolysis shutdown was associated with increased mortality (OR 2.87, 95% CI 1.41–5.83) and VFD < 28 (OR 2.54, 95% CI 1.47–4.39). CONCLUSION: In the injured patient, high blood alcohol levels are associated with increased incidence of fibrinolysis shutdown. This finding has implications for postinjury hemostatic resuscitation as these patients may be harmed by anti-fibrinolytics. 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.


id: cord-011159-k2kca8zl
author: Kamel, Toufik
date: 2020-01-07
txt: ./txt/cord-011159-k2kca8zl.txt
cache: ./cache/cord-011159-k2kca8zl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223716/
doi: 10.1007/s00134-019-05896-4
summary:
  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 ).

title:
  Benefit-to-risk balance of bronchoalveolar lavage in the critically ill. A prospective, multicenter cohort study

abstract:
  PURPOSE: To assess the benefit-to-risk balance of bronchoalveolar lavage (BAL) in intensive care unit (ICU) patients. METHODS: In 16 ICUs, we prospectively collected adverse events during or within 24 h after BAL and assessed the BAL input for decision making in consecutive adult patients. The occurrence of a clinical adverse event at least of grade 3, i.e., sufficiently severe to need therapeutic action(s), including modification(s) in respiratory support, defined poor BAL tolerance. The BAL input for decision making was declared satisfactory if it allowed to interrupt or initiate one or several treatments. RESULTS: We included 483 BAL in 483 patients [age 63 years (interquartile range (IQR) 53–72); female gender: 162 (33.5%); simplified acute physiology score II: 48 (IQR 37-61); immunosuppression 244 (50.5%)]. BAL was begun in non-intubated patients in 105 (21.7%) cases. Sixty-seven (13.9%) patients reached the grade 3 of adverse event or higher. Logistic regression showed that a BAL performed by a non-experienced physician (non-pulmonologist, or intensivist with less than 10 years in the specialty or less than 50 BAL performed) was the main predictor of poor BAL tolerance in non-intubated patients [OR: 3.57 (95% confidence interval 1.04–12.35); P = 0.04]. A satisfactory BAL input for decision making was observed in 227 (47.0%) cases and was not predictable using logistic regression. CONCLUSIONS: Adverse events related to BAL in ICU patients are not infrequent nor necessarily benign. Our findings call for an extreme caution, when envisaging a BAL in ICU patients and for a mandatory accompaniment of the less experienced physicians. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-019-05896-4) contains supplementary material, which is available to authorized users.


id: cord-016732-mdyu69ca
title: Il lavaggio broncoalveolare nelle pneumopatie infiltrative diffuse
author: Pesci, Alberto
date: 2007
txt: ./txt/cord-016732-mdyu69ca.txt
cache: ./cache/cord-016732-mdyu69ca.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121105/
doi: 10.1007/978-88-470-0556-3_24
summary:
  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.

abstract:
  Le pneumopatie infiltrative diffuse costituiscono un gruppo eterogeneo di malattie caratterizzate, istologicamente, dalla presenza di un danno a carico della parete alveolare che puÒ essere infiltrata da cellule infiammatorie/neoplastiche/fluidi/tessuto connettivo. Si parla di forme “diffuse” per sottolineare l’interessamento non solo dell’interstizio, ma anche delle strutture acinari e bronchiolari.


id: cord-016936-cl3kezes
title: Procedure diagnostiche invasive nelle malattie infiltrative diffuse del polmone
author: Poletti, Venerino
date: 2007
txt: ./txt/cord-016936-cl3kezes.txt
cache: ./cache/cord-016936-cl3kezes.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121372/
doi: 10.1007/978-88-470-0556-3_26
summary:
  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] .

abstract:
  Le malattie polmonari che, già all’esordio clinico e/o nel loro decorso, coinvolgono più di un lobo e caratterizzate dall’accumulo od infiltrazione nel lobulo polmonare secondario di sostanze o cellule non normalmente presenti in tale sede o presenti, comunque, in quantità anomala, possono essere definite con il termine di pneumopatie infiltrative diffuse (PID) [1].


id: cord-017123-g1m1y38x
title: Il lavaggio broncoalveolare (BAL) in età pediatrica
author: Sacco, Oliviero
date: 2007
txt: ./txt/cord-017123-g1m1y38x.txt
cache: ./cache/cord-017123-g1m1y38x.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121604/
doi: 10.1007/978-88-470-0556-3_60
summary:
  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.

abstract:
  Il lavaggio broncoalveolare o BAL, permettendo di ottenere le cellule ed i soluti presenti sulla superficie epiteliale del tratto respiratorio distale, si è dimostrato una metodica di ricerca essenziale per lo studio dei meccanismi eziopatogenetici delle malattie del polmone profondo, come ad esempio lo studio delle interstiziopatie, su cui esiste una vastissima letteratura di dati ottenuti con il BAL. Oltre a questo aspetto di metodica di ricerca, il BAL rappresenta perè anche una procedura diagnostica insostituibile nella pratica clinica quotidiana.


id: cord-256424-t3dtabi4
title: Repertoire of Intensive Care Unit Pneumonia Microbiota
author: Bousbia, Sabri
date: 2012-02-28
txt: ./txt/cord-256424-t3dtabi4.txt
cache: ./cache/cord-256424-t3dtabi4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/22389704/
doi: 10.1371/journal.pone.0032486
summary:
  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 ).

abstract:
  Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs). During a three-year period, we tested the bronchoalveolar lavage (BAL) of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls). Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77±2.93). Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.


id: cord-257459-elzhww5a
author: Van Driessche, L.
date: 2017-04-19
txt: ./txt/cord-257459-elzhww5a.txt
cache: ./cache/cord-257459-elzhww5a.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/28425146/
doi: 10.1111/jvim.14668
summary:
  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.

title:
  A Deep Nasopharyngeal Swab Versus Nonendoscopic Bronchoalveolar Lavage for Isolation of Bacterial Pathogens from Preweaned Calves With Respiratory Disease

abstract:
  BACKGROUND: Nonendoscopic bronchoalveolar lavage (BAL) is a practical alternative for a deep nasopharyngeal swab (DNS) to sample the airways of a large number of calves in a short period of time. The extent of commensal overgrowth and agreement of BAL with DNS culture results in preweaned calves are unknown. OBJECTIVES: To compare commensal overgrowth and bacterial culture results between DNS and BAL samples. ANIMALS: A total of 183 preweaned calves (144 with bovine respiratory disease and 39 healthy animals). METHODS: Cross‐sectional study. Deep nasopharyngeal swab and BAL samples were taken from each calf and cultured to detect Pasteurellaceae and Mycoplasma bovis. Agreement and associations between culture results of DNS and BAL samples were determined by kappa statistics and logistic regression. RESULTS: Bronchoalveolar lavage samples were less often polymicrobial, more frequently negative and yielded more pure cultures compared to DNS, leading to a clinically interpretable culture result in 79.2% of the cases compared to only in 31.2% of the DNS samples. Isolation rates were lower in healthy animals, but not different between DNS and BAL samples. Only Histophilus somni was more likely to be isolated from BAL samples. In clinical cases, a polymicrobial DNS culture result did not increase the probability of a polymicrobial BAL result by ≥30%, nor did it influence the probability of a negative culture. A significant herd effect was noted for all observed relationships. CONCLUSIONS AND CLINICAL RELEVANCE: Nonendoscopic BAL samples are far less overgrown by bacteria compared to DNS samples under the conditions of this study, facilitating clinical interpretation and resulting in a higher return on investment in bacteriologic culturing.


id: cord-275757-zpblaa36
author: Buchan, Blake W.
date: 2020-06-24
txt: ./txt/cord-275757-zpblaa36.txt
cache: ./cache/cord-275757-zpblaa36.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1128/jcm.00135-20
doi: 10.1128/jcm.00135-20
summary:
  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.

title:
  Practical Comparison of the BioFire FilmArray Pneumonia Panel to Routine Diagnostic Methods and Potential Impact on Antimicrobial Stewardship in Adult Hospitalized Patients with Lower Respiratory Tract Infections

abstract:
  Lower respiratory tract infections, including hospital-acquired and ventilator-associated pneumonia, are common in hospitalized patient populations. Standard methods frequently fail to identify the infectious etiology due to the polymicrobial nature of respiratory specimens and the necessity of ordering specific tests to identify viral agents. The potential severity of these infections combined with a failure to clearly identify the causative pathogen results in administration of empirical antibiotic agents based on clinical presentation and other risk factors. We examined the impact of the multiplexed, semiquantitative BioFire FilmArray Pneumonia panel (PN panel) test on laboratory reporting for 259 adult inpatients submitting bronchoalveolar lavage (BAL) specimens for laboratory analysis. The PN panel demonstrated a combined 96.2% positive percent agreement (PPA) and 98.1% negative percent agreement (NPA) for the qualitative identification of 15 bacterial targets compared to routine bacterial culture. Semiquantitative values reported by the PN panel were frequently higher than values reported by culture, resulting in semiquantitative agreement (within the same log(10) value) of 43.6% between the PN panel and culture; however, all bacterial targets reported as >10(5) CFU/ml in culture were reported as ≥10(5) genomic copies/ml by the PN panel. Viral targets were identified by the PN panel in 17.7% of specimens tested, of which 39.1% were detected in conjunction with a bacterial target. A review of patient medical records, including clinically prescribed antibiotics, revealed the potential for antibiotic adjustment in 70.7% of patients based on the PN panel result, including discontinuation or de-escalation in 48.2% of patients, resulting in an average savings of 6.2 antibiotic days/patient.


id: cord-281418-mvgp6qfv
author: Soccal, P. M.
date: 2010-07-15
txt: ./txt/cord-281418-mvgp6qfv.txt
cache: ./cache/cord-281418-mvgp6qfv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1086/653529
doi: 10.1086/653529
summary:
  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.

title:
  Upper and Lower Respiratory Tract Viral Infections and Acute Graft Rejection in Lung Transplant Recipients

abstract:
  Background. Lung transplant recipients are frequently exposed to respiratory viruses and are particularly at risk for severe complications. 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. Methods. 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. Results. BAL fluid and biopsy specimens from 343 bronchoscopic procedures performed in 77 patients were analyzed. We also compared paired nasopharyngeal and BAL fluid specimens collected in a subgroup of 283 cases. The overall viral positivity rate was 29.3% in the upper respiratory tract specimens and 17.2% in the BAL samples (P < .001). We observed a significant association between the presence of respiratory symptoms and positive viral detection in the lower respiratory tract (P = .012). Conversely, acute rejection was not associated with the presence of viral infection (odds ratio, 0.41; 95% confidence interval, 0.20–0.88). The recovery of lung function was significantly slower when acute rejection and viral infection were both present. Conclusions. A temporal relationship exists between acute respiratory symptoms and positive viral nucleic acid detection in BAL fluid from lung transplant recipients. We provide evidence suggesting that respiratory viruses are not associated with acute graft rejection during the acute phase of infection.


id: cord-286346-h87vcmrd
author: Mikulska, Malgorzata
date: 2019-02-07
txt: ./txt/cord-286346-h87vcmrd.txt
cache: ./cache/cord-286346-h87vcmrd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30753590/
doi: 10.1093/mmy/myz002
summary:
  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 .

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

abstract:
  Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE®) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia®, cutoff: 0.5 ODI). Patients were classified as proven/probable, possible, and no-IA. "Atypical-IA" referred to patients with lesions other than typical according to 2008-EORTC/MSG and positive mycology. Proven IA was diagnosed in two cases (1.6%), probable in 28 (22.8%), possible in 27 (22%), atypical in 14 (11.4%). qPCR was positive in 39 samples (31.7%). Sensitivity and specificity of qPCR for proven/probable IA (vs no-IA; atypical-IA excluded) were 40% (95% confidence interval [CI]: 23–59) and 69% (95%CI: 55–81), respectively. Sensitivity of qPCR was higher when combined with GM (83%, 95%CI: 65–94) and in those receiving mould-active agents at BAL (61%, 95%CI: 32–86). One sample had TR34/L98H mutation. In conclusion, in high-risk hematology patients with various lung lesions, A. 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.


id: cord-291286-diwigcy9
author: De Schutter, Iris
date: 2011-06-15
txt: ./txt/cord-291286-diwigcy9.txt
cache: ./cache/cord-291286-diwigcy9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/21628484/
doi: 10.1093/cid/cir235
summary:
  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] .

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

abstract:
  Background. Precise etiologic diagnosis in pediatric community-acquired pneumonia (CAP) remains challenging. Methods. 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). Procedural measures were taken to limit contamination risk and quantitative bacterial culture of BAL fluid (significance cutoff point, ≥10(4) colony-forming units/mL) was used. Blood culture results, serological test results, nasopharyngeal secretion findings, and pleural fluid culture results were also assessed, where available. Results. An infectious agent was detected in 76.0% of cases. In 51.2% of infections, aerobic bacteria were isolated, of which 75.0%, 28.9%, and 13.3% were Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae, respectively. Most (97.9%) of the H. influenzae strains were nontypeable (NTHi). H. influenzae was detected in 26.0% of NR-CAP cases and 51.2% of Rec-CAP cases, whereas Mycoplasma pneumoniae was the predominant pathogen in the NR-CAP group (accounting for 34.9% of cases) but not in the Rec-CAP group (19.3%). Viruses were found in 30.4% of cases, with respiratory syncytial virus, parainfluenzaviruses, and influenzaviruses detected most frequently. Mixed infections were found in 18.9% of NR-CAP cases and 30.1% of Rec-CAP cases. Conclusions. A variety of microorganisms were isolated with frequent mixed infection. NTHi was one of the major pathogens found, especially in association with recurrent CAP, possibly because of improved detection with the FOB with BAL procedure. This suggests that the burden of pediatric CAP could be reduced by addressing NTHi as a major causative pathogen.


id: cord-291960-1is0rv6c
author: Piñana, José Luis
date: 2019-02-21
txt: ./txt/cord-291960-1is0rv6c.txt
cache: ./cache/cord-291960-1is0rv6c.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0163445319300581
doi: 10.1016/j.jinf.2019.02.009
summary:
  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.

title:
  Pulmonary cytomegalovirus (CMV) DNA shedding in allogeneic hematopoietic stem cell transplant recipients: Implications for the diagnosis of CMV pneumonia

abstract:
  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. RESULTS: A total of 144 BAL specimens from 123 patients were included. CMV DNA was detected in 56 out of 144 BAL fluid specimens and the median CMV DNA load from patients in whom CMV pneumonia was unlikely or could be tentatively ruled out was 1210 (31–68, 920) IU/ml. The frequency of CMV DNA detection and median CMV DNA loads were comparable, irrespective of the attributable cause of pneumonia. Detection of CMV DNA loads in BAL fluid specimens >500 IU/ml was independently associated with pneumonia-attributable mortality. CONCLUSIONS: The current study highlights the difficulty in establishing universal CMV DNA load thresholds in BAL fluid specimens for distinguishing between CMV pneumonia and pulmonary CMV DNA shedding, and suggests that the presence of CMV DNA in BAL fluid specimens beyond a certain level may have a deleterious impact on patient outcome.


id: cord-292772-xdic7rcy
author: Petini, Matteo
date: 2019-04-26
txt: ./txt/cord-292772-xdic7rcy.txt
cache: ./cache/cord-292772-xdic7rcy.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1177/2050313x19841169
doi: 10.1177/2050313x19841169
summary:
  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.

title:
  Nested–polymerase chain reaction detection of Pneumocystis carinii f. sp. canis in a suspected immunocompromised Cavalier King Charles spaniel with multiple infections

abstract:
  A 7-month-old Cavalier King Charles Spaniel female was referred due to a chronic cough refractory to antibiotic treatments. Laboratory findings showed leukocytosis, increased serum C-reactive protein, hypogammaglobulinemia, and decreased total serum immunoglobulin G concentration. Thoracic radiographs showed a mild bronchial pattern. Cytology of the bronchoalveolar lavage fluid revealed a septic inflammation. Bordetella bronchiseptica, Mycoplasma spp., and Pneumocystis carinii were identified by polymerase chain reaction testing, and Klebsiella pneumonia was cultured from the bronchoalveolar lavage fluid. Moreover, Escherichia coli was also cultured from urine. Pneumocystis spp. identification was done by sequencing of genetic amplicons. The dog died due to cardiopulmonary arrest secondary to a spontaneous pneumothorax on the day following the procedure. This report documents the detection of Pneumocystis carinii f. sp. 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. in cases with negative bronchoalveolar lavage cytology.


id: cord-295718-nt2n9p5v
author: Vissichelli, N. C.
date: 2019-12-31
txt: ./txt/cord-295718-nt2n9p5v.txt
cache: ./cache/cord-295718-nt2n9p5v.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2590088919300290
doi: 10.1016/j.infpip.2019.100029
summary:
  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) .

title:
  Bronchoalveolar lavage to evaluate new pulmonary infiltrates in allogeneic hematopoietic stem cell transplant recipients: impact on antimicrobial optimization

abstract:
  Summary Background Pulmonary complications cause significant morbidity and mortality after allogeneic hematopoietic stem cell transplant (AHSCT). Bronchoscopy with targeted bronchoalveolar lavage (BAL) is often used in AHSCT patients with suspected lower respiratory tract infection (LRTI) to help guide management. Aim To evaluate how positive BAL results change antimicrobial management of AHSCT recipients with suspected LRTI. Methods We performed a retrospective review of BAL results from January 2014 to July 2016 for 54 AHSCT recipients. A positive BAL was determined by culture, multiplex polymerase chain reaction (PCR), Aspergillus galactomannan antigen (AGA), and cytology. Findings BAL was positive for infectious etiologies in 63%, and antimicrobials were adjusted in 48/54 (89%) of patients. Antibacterial escalation was predicted by a positive BAL bacterial culture (OR 7.61, P=0.017). Antibiotic de-escalation was more likely with an elevated AGA (OR 3.86, P=0.035). Antiviral initiation was more likely with positive BAL multiplex PCR (OR 17.33, P=0.010). Antifungals were more likely to be escalated or changed with an elevated AGA (OR 4.33, P=0.020). The patients with a negative BAL were more likely to be started on steroids (OR 0.19, P= 0.043). Conclusions BAL was helpful to determine the etiology of pulmonary complications and optimize antimicrobials. The addition of AGA and multiplex PCR to standard BAL significantly impacted de-escalating antibiotics and adjusting antifungals to provide adequate coverage. The association with an elevated AGA with antibacterial de-escalation highlights a new role for BAL in antimicrobial optimization.


id: cord-302403-kahi8cbc
title: Pulmonary Infections
author: Miller, Robert F.
date: 2009-05-15
txt: ./txt/cord-302403-kahi8cbc.txt
cache: ./cache/cord-302403-kahi8cbc.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/B9780323048255100340
doi: 10.1016/b978-032304825-5.10034-0
abstract: nan
summary:
  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.


id: cord-306346-rft22vo8
title: CXC chemokines and antimicrobial peptides in rhinovirus‐induced experimental asthma exacerbations
author: Rohde, G.
date: 2014-06-23
txt: ./txt/cord-306346-rft22vo8.txt
cache: ./cache/cord-306346-rft22vo8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/24673807/
doi: 10.1111/cea.12313
summary:
  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.

abstract:
  RATIONALE: Rhinoviruses (RVs) are the major triggers of asthma exacerbations. We have shown previously that lower respiratory tract symptoms, airflow obstruction, and neutrophilic airway inflammation were increased in experimental RV‐induced asthma exacerbations. OBJECTIVES: We hypothesized that neutrophil‐related CXC chemokines and antimicrobial peptides are increased and related to clinical, virologic, and pathologic outcomes in RV‐induced exacerbations of asthma. 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. RESULTS: BAL HNP 1–3 and Elafin were higher, CXCL7/NAP‐2 was lower in asthmatics compared with controls at day 4 (P = 0.035, P = 0.048, and P = 0.025, respectively). BAL HNP 1–3 and CXCL8/IL‐8 were increased during infection (P = 0.003 and P = 0.011, respectively). There was a trend to increased BAL neutrophils at day 4 compared with baseline (P = 0.076). BAL HNP 1–3 was positively correlated with BAL neutrophil numbers at day 4. There were no correlations between clinical parameters and HNP1–3 or IL‐8 levels. CONCLUSIONS: We propose that RV infection in asthma leads to increased release of CXCL8/IL‐8, attracting neutrophils into the airways where they release HNP 1–3, which further enhances airway neutrophilia. Strategies to inhibit CXCL8/IL‐8 may be useful in treatment of virus‐induced asthma exacerbations.


id: cord-321393-ffulkqrf
author: Versluys, Anne Birgitta
date: 2015-06-11
txt: ./txt/cord-321393-ffulkqrf.txt
cache: ./cache/cord-321393-ffulkqrf.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.bbmt.2015.06.002
doi: 10.1016/j.bbmt.2015.06.002
summary:
  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.

title:
  High Diagnostic Yield of Dedicated Pulmonary Screening before Hematopoietic Cell Transplantation in Children

abstract:
  Pulmonary complications are an important cause for treatment-related morbidity and mortality in hematopoietic cell transplantation (HCT) in children. The aim of this study was to investigate the yield of our pre-HCT pulmonary screening program. We also describe our management guidelines based on these findings and correlate them with symptomatic lung injury after HCT. 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. We systematically evaluated the yield during the first 5 years of our screening program. We included 142 consecutive children. In 74% of patients, abnormalities were found. In 66% of patients, 1 or more PFT results were <80% of normal. Chest HRCT showed abnormalities in 55%; 19% of these abnormalities were considered “clinically significant.” BAL was abnormal in 43% of patients; respiratory viruses (PCR) were found in 35 patients, fungi (antigen or culture) in 21, and bacteria (culture) in 22. All 3 screening tests contributed separately to clinically relevant information regarding pulmonary status in these pre-HCT children. In 46 patients (33%), screening results had diagnostic and/or therapeutic implications. We found an association between pre-SCT HRCT findings and lung injury after transplantation. 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. Whether this improves patient outcome requires further investigation.


id: cord-325068-j1lfq60o
title: Coronavirus 229E-Related Pneumonia in Immunocompromised Patients
author: Pene, Frédéric
date: 2003-10-01
txt: ./txt/cord-325068-j1lfq60o.txt
cache: ./cache/cord-325068-j1lfq60o.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/13130404/
doi: 10.1086/377612
summary:
  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] .

abstract:
  Coronaviruses strains 229E and OC43 have been associated with various respiratory illnesses ranging from the self-resolving common cold to severe pneumonia. Although chronic underlying conditions are major determinants of severe respiratory virus infections, few data about coronavirus-related pneumonia in immunocompromised patients are available. Here we report 2 well-documented cases of pneumonia related to coronavirus 229E, each with a different clinical presentation. Diagnosis was made on the basis of viral culture and electron microscopy findings that exhibited typical crown-like particles and through amplification of the viral genome by reverse transcriptase—polymerase chain reaction. On the basis of this report, coronaviruses should be considered as potential causative microorganisms of pneumonia in immunocompromised patients.


id: cord-328918-nc0a77r6
author: Kuczia, Pawel
date: 2020-07-13
txt: ./txt/cord-328918-nc0a77r6.txt
cache: ./cache/cord-328918-nc0a77r6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13601-020-00337-8
doi: 10.1186/s13601-020-00337-8
summary:
  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.

title:
  Citrullinated histone H3, a marker of extracellular trap formation, is increased in blood of stable asthma patients

abstract:
  BACKGROUND: Emerging data indicates that extracellular traps (ETs), structures formed by various immune cell types, may contribute to the pathology of noninfectious inflammatory diseases. Histone hypercitrullination is an important step in ETs formation and citrullinated histone H3 (H3cit) is considered a novel and specific biomarker of that process. 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. METHODS: In 60 white adult stable asthmatics and 50 well-matched controls we measured serum levels of H3cit. In asthmatics we also performed bronchoscopy with BAL. We analyzed blood and BAL biomarkers, including interleukin (IL)-4, IL-5, IL-6, IL-10, IL-12p70, IL-17A and interferon γ. For statistical analysis, Mann–Whitney U-test, χ(2) test, one-way ANCOVA, ROC curve analysis and univariate linear regression were applied. Independent determinants of H3cit were established in a multiple linear regression model. RESULTS: Asthma was characterized by elevated circulating H3cit (17.49 [11.25–22.58] vs. 13.66 [8.66–18.87] ng/ml, p = 0.03). In asthmatics positive associations were demonstrated between serum H3cit and lung function variables, including total lung capacity (TLC) (β = 0.37 [95% CI 0.24–0.50]) and residual volume (β = 0.38 [95% CI 0.25–0.51]). H3cit was increased in asthma patients receiving systemic steroids (p = 0.02), as well as in subjects with BAL eosinophilia above 144 cells/ml (p = 0.02). In asthmatics, but not in controls, circulating H3cit correlated well with number of neutrophils (β = 0.31 [95% CI 0.19–0.44]) and monocytes (β = 0.42 [95% CI 0.29–0.55]) in peripheral blood. Furthermore, BAL macrophages, BAL neutrophils, TLC, high-sensitivity C-reactive protein, Il-12p70 and bronchial obstruction degree were independent determinants of H3cit in a multivariate linear regression model. CONCLUSIONS: Asthma is characterized by increased circulating H3cit likely related to the enhanced lung ETs formation. Inhibition of ETs might be a therapeutic option in selected asthma phenotypes, such as neutrophilic asthma.


id: cord-332298-ig1j5z07
title: Equine Asthma: Current Understanding and Future Directions
author: Couetil, Laurent
date: 2020-07-30
txt: ./txt/cord-332298-ig1j5z07.txt
cache: ./cache/cord-332298-ig1j5z07.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32903600/
doi: 10.3389/fvets.2020.00450
summary:
  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.

abstract:
  The 2019 Havemeyer Workshop brought together researchers and clinicians to discuss the latest information on Equine Asthma and provide future research directions. Current clinical and molecular asthma phenotypes and endotypes in humans were discussed and compared to asthma phenotypes in horses. The role of infectious and non-infectious causes of equine asthma, genetic factors and proposed disease pathophysiology were reviewed. Diagnostic limitations were evident by the limited number of tests and biomarkers available to field practitioners. The participants emphasized the need for more accessible, standardized diagnostics that would help identify specific phenotypes and endotypes in order to create more targeted treatments or management strategies. One important outcome of the workshop was the creation of the Equine Asthma Group that will facilitate communication between veterinary practice and research communities through published and easily accessible guidelines and foster research collaboration.


id: cord-335359-4rcj75tc
author: Jia, Bei
date: 2020-01-15
txt: ./txt/cord-335359-4rcj75tc.txt
cache: ./cache/cord-335359-4rcj75tc.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0732889319308983
doi: 10.1016/j.diagmicrobio.2020.114988
summary:
  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.

title:
  Evaluation of a PCR-electrospray ionization mass spectrometry platform for detection and identification of fungal pathogens directly from prospectively collected bronchoalveolar lavage specimens

abstract:
  The incidence of invasive fungal infections is on the rise worldwide due to the growth of the immunocompromised population. 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. In this study, we describe both analytical and clinical performance of the assay, when run with prospectively collected clinical BAL specimens. In 146 patients with probable and possible fungal infections defined by EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria, the PCR/ESI-MS assay demonstrated a sensitivity of 90.9% (95% CI: 76.4–96.9%) and a specificity of 82.3% (95% CI: 74.2–88.2%). This data demonstrates the utility of a non-culture based broad fungal targets molecular diagnostic tool for rapid and accurate diagnosis of invasive fungal infections in patients at risk of developing fungal diseases.


id: cord-335709-pta3nzz9
author: Murphy, Caitlin N.
date: 2020-06-24
txt: ./txt/cord-335709-pta3nzz9.txt
cache: ./cache/cord-335709-pta3nzz9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32350043/
doi: 10.1128/jcm.00128-20
summary:
  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.

title:
  Multicenter Evaluation of the BioFire FilmArray Pneumonia/Pneumonia Plus Panel for Detection and Quantification of Agents of Lower Respiratory Tract Infection

abstract:
  The ability to provide timely identification of the causative agents of lower respiratory tract infections can promote better patient outcomes and support antimicrobial stewardship efforts. Current diagnostic testing options include culture, molecular testing, and antigen detection. These methods may require collection of various specimens, involve extensive sample treatment, and can suffer from low sensitivity and long turnaround times. 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). Semiquantitative results are also provided for the bacterial targets. This paper describes selected analytical and clinical studies that were conducted to evaluate performance of the panel for regulatory clearance. 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. The PN panel showed a sensitivity of 100% for 15/22 etiologic targets using BAL specimens and for 10/24 using sputum specimens. All other targets had sensitivities of ≥75% or were unable to be calculated due to low prevalence in the study population. Specificity for all targets was ≥87.2%, with many false-positive results compared to culture that were confirmed by alternative molecular methods. Appropriate adoption of this test could provide actionable diagnostic information that is anticipated to impact patient care and antimicrobial stewardship decisions.


id: cord-337637-wehstffa
title: Comparison of atopic and nonatopic children with chronic cough: Bronchoalveolar lavage cell profile
author: Ferreira, Flavia de A
date: 2007-08-28
txt: ./txt/cord-337637-wehstffa.txt
cache: ./cache/cord-337637-wehstffa.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/17726706/
doi: 10.1002/ppul.20648
summary:
  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 ).

abstract:
  Chronic cough is a common complaint in children and its relationship with asthma is controversial. The aim of the present study was to determine the pattern of airway inflammation in atopic and nonatopic children with chronic cough, and to investigate whether atopy is a predictive factor for eosinophilic inflammation in cough. 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). Atopy was defined as an elevated total serum IgE or a positive RAST test. Both atopic and nonatopic children with persistent cough had an increase in total cells/ml in BAL (atopic: median 39 × 10(4), range: 20–123; nonatopic: median 22 × 10(4), range: 17–132) compared to nonatopic controls (median 11 × 10(4), range 9–30). The increases were mainly in neutrophils (atopic: median 17%, range 2.5–88.5%; nonatopic: median 6%, range 1.0–55.0%) compared to controls (median 1.55%, range 0.5–7.0%; atopics vs. controls, P < 0.005). There were no significant increases in eosinophils, lymphocytes, epithelial cells, or mast cells. Eosinophils were elevated in only 5/11 atopic and none of the nonatopic children. The increased percentage of neutrophils in the BAL fluid of atopic and nonatopic children with persistent cough could be due to an underlying inflammatory process driving the cough, or even conceivably, due to the effect of coughing itself. In this highly selected series, the absence of eosinophilic inflammation in the majority suggests that most would be predicted not to respond to inhaled corticosteroid therapy. This study underscores the need to be cautious about treating coughing children with inhaled corticosteroids, even in the context of a tertiary referral practice. Pediatr Pulmonol. 2007;42:857–863. © 2007 Wiley‐Liss, Inc.


id: cord-340544-ce5ic04g
title: Microbiologic yield of bronchoalveolar lavage specimens from stem cell transplant recipients
author: Sakata, Kenneth K.
date: 2017-04-12
txt: ./txt/cord-340544-ce5ic04g.txt
cache: ./cache/cord-340544-ce5ic04g.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/tid.12684
doi: 10.1111/tid.12684
summary:
  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.

abstract:
  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. METHODS: Between January 1, 2009, and July 31, 2013, we reviewed medical records of 125 SCT recipients who underwent 179 BALs. In addition to demographic information and details pertaining to their SCT, a comprehensive review of their microbiologic data was performed and recorded. 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. CONCLUSIONS: Although an initial BAL sample in this population provides crucial microbiologic information, repeating the procedure within 30 days may have minimal additional microbiologic yield. BAL continues to be an essential diagnostic tool in SCT recipients undergoing an infectious pulmonary work‐up.


id: cord-346411-d2re00r9
author: Boonyaratanakornkit, Jim
date: 2020-02-01
txt: ./txt/cord-346411-d2re00r9.txt
cache: ./cache/cord-346411-d2re00r9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/infdis/jiz470
doi: 10.1093/infdis/jiz470
summary:
  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.

title:
  Predictive Value of Respiratory Viral Detection in the Upper Respiratory Tract for Infection of the Lower Respiratory Tract With Hematopoietic Stem Cell Transplantation

abstract:
  BACKGROUND: Hematopoietic cell transplant (HCT) recipients are frequently infected with respiratory viruses (RVs) in the upper respiratory tract (URT), but the concordance between URT and lower respiratory tract (LRT) RV detection is not well characterized. METHODS: Hematopoietic cell transplant candidates and recipients with respiratory symptoms and LRT and URT RV testing via multiplex PCR from 2009 to 2016 were included. Logistic regression models were used to analyze risk factors for LRT RV detection. RESULTS: Two-hundred thirty-five HCT candidates or recipients had URT and LRT RV testing within 3 days. Among 115 subjects (49%) positive for a RV, 37% (42 of 115) had discordant sample pairs. Forty percent (17 of 42) of discordant pairs were positive in the LRT but negative in the URT. Discordance was common for adenovirus (100%), metapneumovirus (44%), rhinovirus (34%), and parainfluenza virus type 3 (28%); respiratory syncytial virus was highly concordant (92%). Likelihood of LRT detection was increased with URT detection (oods ratio [OR] = 73.7; 95% confidence interval [CI], 26.7–204) and in cytomegalovirus-positive recipients (OR = 3.70; 95% CI, 1.30–10.0). CONCLUSIONS: High rates of discordance were observed for certain RVs. Bronchoalveolar lavage sampling may provide useful diagnostic information to guide management in symptomatic HCT candidates and recipients.


id: cord-352502-vdm55zvq
title: Response to: Factors limiting the utility of bronchoalveolar lavage in the diagnosis of COVID-19
author: Salton, Francesco
date: 2020-09-17
txt: ./txt/cord-352502-vdm55zvq.txt
cache: ./cache/cord-352502-vdm55zvq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32943403/
doi: 10.1183/13993003.03383-2020
summary:
  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.

abstract:
  We aimed at evaluating not the diagnostic yield of BAL in COVID-19, but the agreement between negative upper respiratory tract swabs and BAL to exclude COVID-19, stressing that BAL is likely negative if swabs and chest CT are concordantly negative.


id: cord-353256-7nfklun9
title: The value of flexible bronchoscopy in pulmonary infections of immunosuppressed children
author: Eroglu‐Ertugrul, Nesibe Gevher
date: 2019-11-22
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url: https://www.ncbi.nlm.nih.gov/pubmed/31710418/
doi: 10.1111/crj.13103
summary:
  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).

abstract:
  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. METHODS: We retrospectively evaluated 132 immunosuppressed children who underwent FB and BAL because pulmonary complications between January 1999 and May 2014 at the Hacettepe University Hospital Pediatric Pulmonology Unit. Two groups, Group I (n = 106) and Group II (n = 26), consisted of patients who had primary or secondary immunodeficiency and those who were immunosuppressed because BMT, respectively. Radiological findings before FB and macroscopic and microscopic findings of the procedure were evaluated. RESULTS: FB and BAL were diagnostic in 86/132 patients (65.1%) and the antimicrobial treatment changed for 75/132 patients (56.8%). The most common pathogen was bacteria (Streptococcus pneumoniae was the leading one). Bacteria were more frequent in Group I than Group II (P = .008). No significant difference in radiological findings between Groups I and II was found. Considering all patients, a significant association was detected between viral pathogens and radiologically interstitial infiltration and a ground‐glass appearance (P = .003). However, no significant association was detected between bacterial and fungal pathogens and the radiological findings. CONCLUSION: In immunosuppressed patients, FB and BAL should be evaluated early for clarifying the causative agents. Then, appropriate treatments can be utilised and the side effects and high cost of unnecessary treatment may be mitigated.


id: cord-355623-tmr1ieg1
title: When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children
author: Gallucci, Marcella
date: 2020-08-07
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url: https://doi.org/10.3389/fped.2020.00433
doi: 10.3389/fped.2020.00433
summary:
  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.

abstract:
  Chronic cough is defined as a daily cough that persists longer than 4 weeks. 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. The diagnosis is mainly clinical; generally, no instrumental examinations are necessary. The most common bacteria found in the bronchoalveolar lavage (BAL) of subjects with PBB include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Nowadays, there is no certain evidence of the role of viruses in PBB pathogenesis even though different types of viruses have been detected in BAL from children with PBB. Airway malacia is commonly found in children with PBB; conversely, there is no correlation with any type of immunodeficiency. Amoxicillin-clavulanate acid is the most commonly used antibiotic, as first-line, prolonged therapy (longer than 2 weeks) is sometimes required to cough resolution. When the wet cough does not improve despite prolonged antibiotic treatment, an underlying disease should be considered. Moreover, there are several hypotheses of a link between PBB and bronchiectasis, as recent evidences show that recurrent PBB (>3 episodes/years) and the presence of H. influenzae infection in the lower airways seem to be significant risk factors to develop bronchiectasis. This underlines the importance of a close follow-up among children with PBB and the need to consider chest computerized tomography (CT) in patients with risk factors for bronchiectasis. In this brief review, we summarize the main clinical and pathogenetic findings of PBB, a disease that may be related to a relevant morbidity and decreased quality of life during the pediatric age.


