Sr. Lewin et al., THE ROLE OF BRONCHOSCOPY IN THE DIAGNOSIS AND TREATMENT OF PULMONARY-DISEASE IN HIV-INFECTED PATIENTS, Australian and New Zealand Journal of Medicine, 25(2), 1995, pp. 133-139
Background: Pulmonary disease is the most common reason for presentati
on and the major cause of death in HIV-infected patients. There has be
en an evolution in the optimal approach to the investigation of a pulm
onary infiltrate in HIV-infected patients since the introduction of in
duced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP)
. Aims: To evaluate the usefulness of flexible fibreoptic bronchoscopy
(FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and
bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV-
infected patients and to examine the effect of FFB on changes in thera
py and survival. Methods: The histories of all HIV-infected patients r
eferred to Fairfield Hospital for FFB between January 1990 and June 19
93 were examined retrospectively.Results: Forty-two FFB were performed
on 41 patients (40 male and one female). Definitive diagnoses made at
FFB included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n
= 5), PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2
), cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans pn
eumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa pne
umonia (n = 1). TEE and BE did not provide a diagnosis for diseases no
t seen macroscopically at FFB or diagnosed by BAL. FFB findings altere
d diagnosis in 21/42 (50%) presentations and changed therapy in 26/42
(62%) cases. Conclusion: FFB together with BAL altered the working dia
gnosis and changed therapy in a significant number of patients. TBB an
d BE should not be routinely performed in all patients as these proced
ures are of limited value in this setting.