Study of bronchoalveolar lavage in HIV-infected children.

ulmonary complications are common among HIV-infected hildren. Early diagnosis and immediate care are important in rder to reduce morbidity and mortality. Bronchoscopy with ronchoalveolar lavage (BAL) have been routinely used in the iagnostic approach of pulmonary complications caused by IV-1.1,2 Due to immune defects, the risk of HIV-infected people o develop pneumonia is 10 to 100 times higher when comared to HIV-uninfected people. Infected patients present an ncreased susceptibility to pyogenic bacterial, viral, protozoal nd mycobacterial infections and about 80% of them develop ulmonary disease more frequently and more severe.1,2 Bronchoscopy with BAL has been used in the diagnosis of hese types of pneumonia in children and adults. Unlike lung iopsy, BAL is safe even in young infants, being less aggressive, nd presenting less risk of complications.3 The aim of this study was to evaluate the importance of BAL o diagnose lung disease in HIV-infected children correlating pidemiology and laboratory data. We retrospectively studied the microbiology and cytology ata of BAL specimens performed by flexible bronchoscopy n HIV-infected children with pneumonia unresponsive o empiric antibiotic therapy, referred to the Respiratory ndoscopy Service at Antonio Pedro University Hospital Universidade Federal Fluminense (APUH-UFF) from Janary 2000 to December 2009. Approval for this study was btained from the APUH-FFU and Research Ethics Committee CEP/HUAP/CAAE: 0178.0.258.000-10). Flexible bronchoscopy ith BAL was carried out as previously described.3 The recovred lavage fluid was sent for microbiological (direct Acid Fast nd Gram stain, and culture) and cytology (global and specific ytology) analysis. Using the protected catheter or quantiative culture can minimize the often contamination of the ample BAL when passing through the upper airway. We used uantitative culture in all study samples. 45 bronchoscopies ere performed in 33 patients. Age ranged from 1 month to 6 years (median = 4 years, interquartile range = 1–6.5). The indications for bronchoscopy with BAL are presented n Table 1. Ten children (four suspected of having tuberculosis TB), three with pneumonia, two with persistent radiological imaging, and another with interstitial pneumonia) had bronchoscopic signs suggestive of TB (widening of carina and/or extrinsic compression of the tracheobronchial tree), one of them was confirmed by culture. All bronchoscopy exams had a diffuse inflammatory process except one, with interstitial pneumonia which was normal. Cytological analysis in 12/45 (26.6%) of BAL showed neutrophilic (6/12), lymphocytic (4/12) and mixed cellularity, both neutrophilic and lymphocytic (2/12). The diagnosis was performed in 27/45 cases (60%): TB (15/45 = 33.3%), lymphocytic pneumonia (5/45 = 11.1%), bacterial infection (6/45 = 13.3%) and fungal infection (1/45 = 2.2%). The diagnostic yield of BAL in our study was 60.4%, similar to the literature (58%). Pneumonia was the main indication (14/45 = 31.1%) for performing BAL, and this confirms the high frequency of lung disease in immunocompromised patients. Sheikh et al.2 studied 104 HIV-infected children and found that 75 (45.7%) had pneumonia with no complications, 24 (14.6%) recurrent pneumonia, and 18 (10.9%) persistent pneumonia. Etiological confirmation of pulmonary diseases in HIVinfected children is crucial, since these patients often have severe infectious pulmonary complications that can cause death. Opportunistic bacteria, mycobacteria, viruses and fungi are pathogens that can be isolated, especially Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, Pneumocystis jiroveci and Streptococcus viridans.1,2,4