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Irish Journal of Medical Science

, Volume 182, Issue 2, pp 177–183 | Cite as

Utility of bronchoalveolar lavage in the diagnosis of pulmonary infection in children with haematological malignancies

  • U. Rao
  • A. Piccin
  • A. Malone
  • K. O’Hanlon
  • F. Breatnach
  • A. O’Meara
  • M. McDermott
  • K. Butler
  • N. O’Sullivan
  • J. Russell
  • A. O’Marcaigh
  • O. P. Smith
Original Article

Abstract

Background

Fibre-optic bronchoscopy with bronchoalveolar lavage (BAL) is a safe procedure and is associated with low morbidity and mortality in immunocompromised children. Although many studies have highlighted the advantages of positive BAL results in the diagnosis of pulmonary infections, there have been few reports examining the impact of a negative BAL result on clinical management in immunocompromised children on empiric broad-spectrum antimicrobial therapy.

Aim

The aim of this study was to evaluate BAL in the diagnosis of pulmonary infections in children with haematological malignancies who develop pneumonia unresponsive to empiric antimicrobial therapy, and also to determine whether a negative BAL result contributed to the clinical management of these patients.

Materials and methods

A retrospective review of 44 BAL procedures performed in 33 children with haematological malignancy diagnosed and treated at Our Lady’s Children Hospital, Crumlin, Dublin 12, Ireland, over a 10-year period was carried out.

Results

We identified a pathogen causing pneumonia in 24 of 44 BAL procedures (54.5 %). The BAL procedure resulted in modification of antimicrobial treatment after 20 of 24 procedures with positive results (83.3 %) in 16 of 20 patients (80 %). Management was changed after 8 of 20 procedures with negative results (40 %) in 8 of 18 patients (44.4 %). The procedure was well tolerated in all patients.

Conclusions

Our study supports the use of bronchoscopy with BAL as a diagnostic intervention in this patient population. We consider BAL a safe procedure from which both positive and negative results contribute to the patient’s clinical management.

Keywords

Children Bronchoalveolar lavage Pulmonary disease Haematological malignancies Antimicrobial therapy 

Notes

Conflict of interest

None.

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Copyright information

© Royal Academy of Medicine in Ireland 2012

Authors and Affiliations

  • U. Rao
    • 1
  • A. Piccin
    • 1
  • A. Malone
    • 1
  • K. O’Hanlon
    • 1
  • F. Breatnach
    • 1
  • A. O’Meara
    • 1
  • M. McDermott
    • 2
  • K. Butler
    • 3
  • N. O’Sullivan
    • 4
  • J. Russell
    • 5
  • A. O’Marcaigh
    • 1
    • 6
  • O. P. Smith
    • 1
    • 6
  1. 1.Departments of Haematology and OncologyOur Lady’s Children’s HospitalDublin 12Ireland
  2. 2.Department of HistopathologyOur Lady’s Children’s HospitalDublin 12Ireland
  3. 3.Department of Infectious DiseasesOur Lady’s Children’s HospitalDublin 12Ireland
  4. 4.Department of MicrobiologyOur Lady’s Children’s HospitalDublin 12Ireland
  5. 5.Department of OtolaryngologyOur Lady’s Children’s HospitalDublin 12Ireland
  6. 6.Trinity CollegeUniversity of DublinDublinIreland

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