HOSPITAL-ACQUIRED CANDIDA AND ASPERGILLUS PNEUMONIA DIAGNOSTIC APPROACHES AND CLINICAL FINDINGS

Bronchoscopy with bronchoalveolar lavage (BAL), collection of bronchia l secretions (BS) and/or high resolution computed tomography (CT) of t he lungs was performed in 70 patients with candida and/or aspergillus pneumonia. The sensitivity of bronchoscopy in detecting histologically proven fungal disease was 59%. Characteristic CT signs were found in 11 of 14 patients with candida pneumonia and 16 of 19 patients with as pergillosis. The more frequent use of bronchoscopy and CT scans betwee n 1990 and 1992 compared with 1986-1989 for the differential diagnosis of new pulmonary infiltrates in immunocompromised patients resulted i n earlier antifungal treatment (14 vs. nine days; P < 0.025). In the s econd treatment period survival was improved from 36 to 50% (not signi ficant). Bronchoscopy and high resolution CT scans are mutually comple mentary diagnostic tools and should be performed as early as possible in the course of pneumonia in patients at high risk of fungal diseases .