Value of Bronchoalveolar Lavage Fluid Cytology in the Diagnosis of Pneumocystis jirovecii Pneumonia: A Review of 30 Cases

Sung, Ji-Youn,Han, Joung-Ho,Oh, Young-Lyun,Suh, Gee-Young,Jeon, Kyeong-Man,Kim, Tae-Eun The Korean Academy of Tuberculosis and Respiratory 2011 Tuberculosis and Respiratory Diseases Vol.71 No.5

Background: Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP). Methods: We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated. Results: All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid. Conclusion: BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.

Value of Bronchoalveolar Lavage Fluid Cytology in the Diagnosis of Pneumocystis jirovecii Pneumonia: A Review of 30 Cases

( Ji Youn Sung ),( Joungho Han ),( Young Lyun Oh ),( Gee Young Suh ),( Kyeong Man Jeon ),( Tae Eun Kim ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.5

Background: Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP). Methods: We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated. Results: All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid. Conclusion: BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.

폐 침윤을 동반한 급성 중증 환자의 기관지 폐포 세척액에서 측정한 Pre-B-Cell Colony-Enhancing Factor의 임상적 유용성

이광하 ( Kwang Ha Lee ),홍상범 ( Sang Bum Hong ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.5

Background: Pre-B-cell colony enhancing factor (PBEF) has been suggested as a novel biomarker in sepsis and acute lung injury. We measured the PBEF in bronchoalveolar lavage (BAL) fluid of acute critically ill patients with lung infiltrates in order to evaluate the clinical utility of measuring PBEF in BAL fluid. Methods: BAL fluid was collected by bronchoscope from 185 adult patients with lung infiltrates. An enzyme-linked immunosorbent assay was then performed on the collected fluids to measure the PBEF. Results: Mean patient age was 59.9±14.5 years and 63.8% of patients were males. The mean concentration of PBEF in BAL fluid was 17.5±88.3 ng/mL, and patients with more than 9 ng/mL of PBEF concentration (n=26, 14.1%) had higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores on the BAL exam day. However, there were no significant differences in clinical characteristics between survivors and non-survivors. In patients with leukocytosis (n=93) seen on the BAL exam day, the linear regression analysis revealed a significant, positive relationship between PBEF and APACHE II (r2=0.06), SOFA score (r2=0.08), Clinical Pulmonary Infection Score (r2=0.05), and plateau pressure in patients on ventilators (r2=0.07) (p<0.05, respectively). In addition, multivariate regression analysis with PBEF as a dependent variable showed that the plateau pressure (r2=0.177, p<0.05) was correlated positively with PBEF. Conclusion: The PBEF level in the BAL fluid may be a useful, new biomarker for predicting the severity of illness and ventilator-induced lung injury in critically ill patients with lung infiltates and leukocytosis.

기관지폐포세척액의 이중음성 T 림프구와 폐질환의 연관성 분석

장해봉,이아진,김민지,전창호,서현석,현대성,김상경 대한진단검사의학회 2015 Laboratory Medicine Online Vol.5 No.1

Background: Cellular analysis of bronchoalveolar lavage fluid (BALF) is a useful diagnostic tool for interstitial lung diseases (ILDs). The lymphocytes in BALF consist of CD3+CD4+ T cells (T4), CD3+CD8+ T cells (T8), and a few B cells. However, sometimes, an increased number of CD3+CD4-CD8- T cells (double-negative T cells, DNTs) are noted in BALF. It is known that DNTs in the blood are associated with immunoregulation and autoimmune diseases. However, there are only few studies on DNTs in BALF. We evaluated the DNTs in BALF in patients with pulmonary diseases. Methods: Immunophenotyping results of the BALF obtained from 122 pulmonary disease patients over an 8-yr period were reviewed. T-lymphocyte subsets (T4, T8, and DNT) and inflammatory markers were analyzed for each group of clinical diagnosis. T-lymphocyte percentage of more than 15% of the total cells was defined as BALF lymphocytosis, and DNT percentage of more than 5% of T lymphocytes was defined as high DNT. Results: The most frequent diseases found in the patients were pneumonia (31.6%), autoimmune-related ILDs (18.0%), hypersensitivity pneumonitis (10.7%), and organizing pneumonia (10.7%). However, the occurrence of autoimmune-related ILDs was significantly high (40%) in patients with lymphocytosis and high DNT (P=0.002). All lung cancer patients showed lymphocytosis with high DNT. In addition, CD3-signal intensities of DNTs were significantly higher than those of other T-lymphocyte subtypes (P=0.003). Conclusion: The number of DNTs in BALF was increased in patients with autoimmune-related ILDs and lung cancer. High DNTs in BALF are useful as supportive diagnostic tools for autoimmune-related ILDs. 배경: 기관지폐포세척액의 세포분석은 간질성폐질환환자에서 유용한 진단도구로 사용된다. 기관지폐포세척액의 림프구들은 CD3 +CD4+ T 림프구(T4)와 CD3+CD8+ T 림프구(T8), 그리고 일부 B 림프구로 구분된다. 그러나 가끔씩 CD3+CD4-CD8- T 림프구(DNT)가 확인된다. 혈액에서 확인되는 DNT는 면역조절기능과 자가면역질환과 연관성이 알려져 있으나 기관지폐포세척액에서의 역할은 아직 명확하지 않다. 본 연구에서는 기관지폐포세척액의 DNT 증가 소견과 폐질환의 연관성을 알아보고자 하였다. 방법: 8년간의 122예의 유세포분석 결과를 확인하고 각 임상 진단별 T 림프구 아형들(T4, T8, DNT)과 염증표지자를 후향적으로 분석하였다. 림프구가 15% 이상으로 증가된 경우를 림프구증가성질환으로, DNT가 5% 이상인 경우를 증가소견으로 구분하였다. 결과: 전체 환자군에서는 폐렴(31.6%), 자가면역관련폐질환(18.0%), 과민성폐렴(10.7%), 기질화폐렴(10.7%)의 순서로 상병의 빈도가 나타났다. 그러나 림프구 증가와 DNT 증가가 동반된 그룹에서는 자가면역관련폐질환 상병이 확연하게 높은 빈도를 보였다(40%). 모든 폐암 환자들은 림프구증가와 DNT 증가가 동반된 그룹에 속했다. 또한 DNT의 CD3 신호강도는 다른 T 림프구 아형들의 CD3 신호강도에 비해 유의하게 높았다(P=0.003). 결론: 기관지폐포세척액의 DNT는 자가면역관련폐질환과 폐암에서 증가하는 소견을 보인다. 기관지폐포세척액의 DNT 증가소견은 자가면역관련 폐질환의 진단에 보조적인 도구로 사용될 수 있을 것이다.

CHANGES IN SUBPOPULATION OF BRONCHOALVEOLAR LAVAGE FLUID IN THE PULMONARY FIBROSIS INDUCED BY BLEOMYCIN OR PEPLOMYCIN

Kim, Dae-Joong Korean Society of ToxicologyKorea Environmental Mu 1993 Toxicological Research Vol.9 No.2

Present studies were carried out in order to estabilish the bronchoalveolar lavage method and to examine the response of bleomycin and peplomycin on the total cell number and the subpoulations of bronchoalveolar lavage fluid. A total of 24 male F344 rats, weighing 300-350 mg, were divided into 3 groups. Animals recelved either belomycin (BLM` 0.75 mg/0.2 ml/rat), peplomycin (PLM` 0.25mg/0.2ml/rat) for groups 2 and 3 or an equal volume of sterile saline lacking drugs for controls (group 1).

Protective effects of pyrrolidine dithiocarbamate against airway inflammation in the ovalbumin-induced mouse model

Kwak, Hyun Jeong,Song, Jin Sook,Heo, Jun Yeong,Yang, Sung Don,Nam, Ji Yeon,Cho, Young Sik,Cheon, Hyae Gyeong Elsevier 2008 european journal of pharmacology Vol.590 No.1

<P><B>Abstract</B></P><P>Pyrrolidine dithiocarbamate (PDTC) is known to exert anti-tumor and anti-inflammatory effects. However, the effects of PDTC against airway inflammation and its underlying mechanisms have not been reported. In the present study, we examined the protective effects of PDTC in a murine model of asthma induced by ovalbumin. PDTC reduced the number of infiltrating inflammatory cells in concert with reduced eosinophil peroxidase (EPO) activity in bronchoalveolar lavage fluid. In parallel, PDTC decreased airway hyperresponsiveness in a dose dependent manner. All these effects were correlated with heme oxygenase-1 (HO-1) mRNA and protein induction, and reversed by ZnPP, a HO-1 inhibitor. In addition, PDTC reduced the secretion of Th<SUB>2</SUB> cytokines such as IL-4 and IL-5, whereas ZnPP blocked the inhibitory effects of PDTC on Th<SUB>2</SUB> cytokine secretion. These results suggest that PDTC protects against airway inflammation at least in part via HO-1 induction, and that inhibitory action on Th<SUB>2</SUB> cytokines may be associated with the protective mechanism of PDTC.</P>

비강내 점적 노출을 통한 산화 알루미늄 나노입자의 폐독성 평가

권정택,서균백,이미미,김현미,심일섭,조은혜,김필제,최경희,Kwon, Jung-Taek,Seo, Gyun-Baek,Lee, Mimi,Kim, Hyun-Mi,Shim, Ilseob,Jo, Eunhye,Kim, Pilje,Choi, Kyunghee 한국환경보건학회 2013 한국환경보건학회지 Vol.39 No.1

Objective: The use of nanoparticle products is expected to present a potential harmful effect on consumers. Also, the lack of information regarding inhaled nanoparticles may pose a serious problem. In this study, we addressed this issue by studying pulmonary toxicity after nasal instillation of Al-NPs in SD rats. Methods: The animals were exposed to Al-NPs at 1 mg/kg body weight (low dose), 20 mg/kg body weight (medium dose) and 40 mg/kg body weight (high dose). To determine pulmonary toxicity, bronchoalveolar lavage (ts.AnBAL) fluid analysis and histopathological examination were conducted in rats. In addition, cell viability was investigated at 24 hours after the treatment with Al-NPs. Results: BAL fluid analysis showed that total cells (TC) count and total protein (TP) concentrations increased significantly in all treatment groups, approximately two to three times. Also, lactate dehydrogenase (LDH) and cytokines such as TNF-alpha and IL-6 dose-dependently increased following nasal instillation of Al-NPs. However, polymorphonuclear leukocytes (PMNs) levels showed no significant changes in a dose dependant manner in BAL fluid. In the cytotoxicity analysis, the treatment of Al-NPs significantly and dose-dependently induced cell viability loss (20 to 30%) and damage of cell membrane (5 to 10%) in rat normal lung epithelial cells (L2). Conclusions: Our results suggest that inhaled Al-NPs in the lungs may be removed quickly by alveolar macrophages with minimal inflammatory reaction, but Al-NPs have the potential to affect lung permeability. Therefore, extensive toxicity evaluations of Al-NPs are required prior to their practical application as consumer products.

Standardization of Bronchoalveolar Lavage Method Based on Suction Frequency Number and Lavage Fraction Number Using Rats

Song, Jeong-Ah,Yang, Hyo-Seon,Lee, Jin-Soo,Kwon, Soon-Jin,Jung, Kyung-Jin,Heo, Jeong-Doo,Cho, Kyu-Hyuk,Song, Chang-Woo,Lee, Kyu-Hong Korean Society of ToxicologyKorea Environmental Mu 2010 Toxicological Research Vol.27 No.3

Bronchoalveolar lavage (BAL) is a useful tool in researches and in clinical medicine of lung diseases because the BAL fluid contains biochemical and cytological indicators of the cellular response to infection, drugs, or toxicants. However, the variability among laboratories regarding the technique and the processing of the BAL material limits clinical research. The aim of this study was to determine the suction frequency and lavage fraction number necessary to reduce the variability in lavage using male Sprague-Dawley rats. We compared the total cell number and protein level of each lavage fraction and concluded that more cells and protein can be obtained by repetitive lavage with a suction frequency of 2 or 3 than by lavage with a single suction. On the basis of total cell recovery, approximately 70% of cells were obtained from fractions 1~3. The first lavage fraction should be used for evaluation of protein concentration because fractions 2~5 of lavage fluid were diluted in manifolds. These observations were confirmed in bleomycin-induced inflamed lungs of rats. We further compared the BAL data from the whole lobes with data from the right lobes and concluded that BAL data of the right lobes represented data of the whole lobes. However, this conclusion can only be applied to general lung diseases. At the end, this study provides an insight into the technical or analytical problems of lavage study in vivo.

Standardization of Bronchoalveolar Lavage Method Based on Suction Frequency Number and Lavage Fraction Number Using Rats

Jeong-Ah Song,Hyo-Seon Yang,Jinsoo Lee,Soonjin Kwon,Kyung Jin Jung,Jeong-Doo Heo,Kyu-Hyuk Cho,Chang Woo Song,Kyuhong Lee 한국독성학회 2010 Toxicological Research Vol.26 No.3

Bronchoalveolar lavage (BAL) is a useful tool in researches and in clinical medicine of lung diseases because the BAL fluid contains biochemical and cytological indicators of the cellular response to infection, drugs, or toxicants. However, the variability among laboratories regarding the technique and the processing of the BAL material limits clinical research. The aim of this study was to determine the suction frequency and lavage fraction number necessary to reduce the variability in lavage using male Sprague-Dawley rats. We compared the total cell number and protein level of each lavage fraction and concluded that more cells and protein can be obtained by repetitive lavage with a suction frequency of 2 or 3 than by lavage with a single suction. On the basis of total cell recovery, approximately 70% of cells were obtained from fractions 1~3. The first lavage fraction should be used for evaluation of protein concentration because fractions 2~5 of lavage fluid were diluted in manifolds. These observations were confirmed in bleomycin-induced inflamed lungs of rats. We further compared the BAL data from the whole lobes with data from the right lobes and concluded that BAL data of the right lobes represented data of the whole lobes. However, this conclusion can only be applied to general lung diseases. At the end, this study provides an insight into the technical or analytical problems of lavage study in vivo.

폐렴의 진단에서 정량적 기관지폐포 세척액 배양의 유용성

한태호(Tae Ho Hahn),장명국(Myoung Kuk Jang),김성균(Seong Gyun Kim),이자영(Ja Young Lee),이재명(Jae Myung Lee),김동규(Dong Kyu Kim),최정은(Jeong Eun Choi),모은경(Eun Kyung Mo),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Background: The aim of this study is to evaluate the usefulness of quantitative culture of bronchoalveolar lavage (BAL) fluid for the diagnosis of bacterial pneumonia and identification of causative agents. Methods: Study group consisted of 30 epiaodes in 28 patients, enrolled from January 1995 through June 1996. Inclusion criteria were 1) presence of respiratory symptoms such as cough, sputum or dyspnea 2) increased peripheral blood leukocyte count (≥11,000/mm³) 3) Fever (≥38.3ºC) 4) purulent sputum 5) new or progressive infiltrate on chest radiography. For the diagnosis of pneumonia and its causative agents, sputum smear and culture, blood culture and BAL fluid studies were performed. BAL fluid studies included differential count of white blood cell, BAL fluid smear and culture, detection of elastin fibers and presence of intracellular organisms (ICO). Quantitative culture of BAL fluid was considered positive if colony forming units was more than 1.0×10(4)/ml. Positive criteria for ICO was presence of microorganism in more than five per 100 of phagocytes, Result: Recruited were 22 males and 6 females. The mean age was 57.5±13.5 years (range 25-84), Of 30 episodes underwent BAL fluid studies, 19 cases were diagnosed to be bacterial pneumonia, S. aureus (7 cases) was the most common causative agent and was followed by P. aeruginosa (4), E. cloacae (2), A baumanii (1), H. influenzae (1) and a-hemolytic Streptococcus (1). Sensitivity of quantitative culture of BAL fluid for the diagnosis of bacterial pneumonia was 68.4% and its specificity was 63.6%. Elastin fibers were detected in 5 cases (31%) and ICO over 5% in 3 cases (15.7%). When criteria of quantitative culture of BAL fluid, detection of ICO and elastin fibers were applied together, diagnostic rate of pneumonia was 84.2% (16/19). Conclusion: Quantitative culture of BAL fluid was sensive and specific compared to sputum and b1ood culture for the diagnosis of bacterial pneumonia, It was suggested that detection of ICO and elastic fibers in BAL fluid could raise the diagnostic rate of bacterial pneumonia.