Bronchoscopic diagnosis of pulmonary coccidioidomycosis comparison of cytology, culture, and transbronchial biopsy

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Abstract

The results of all fiberoptic bronchoscopic examinations that detected Coccidioides immitis at two medical centers in an area endemic for coccidioidomycosis were retrospectively reviewed. Coccidioides immitis was detected by cytologic examination of fluid from either bronchial wash or bronchoalveolar lavage (BAL) fluid in eight (42%) of 19 HIV-infected patients and in 11 (31%) of 35 patients without HIV infection (P = 0.627). In all cases, the fluid samples grew C. immitis. The median time to positive identification of the fungus was 25 days. Preliminary identification of C. immitis, however, took a median of 3.5 days (range, 2-9 days) in 10 patients on whom these data were available. Transbronchial biopsy was performed simultaneously in eight cases, and C. immitis was identified by morphologic examination in all eight. These results indicate that cytologic examination of bronchial wash or BAL fluid from patients with and without HIV infection is diagnostic in less than half of cases of pulmonary coccidioidomycosis. Culture of the same fluid appears to be more sensitive than cytologic examination in establishing this diagnosis.

Original languageEnglish (US)
Pages (from-to)83-87
Number of pages5
JournalDiagnostic Microbiology and Infectious Disease
Volume18
Issue number2
DOIs
StatePublished - 1994

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Coccidioides
Coccidioidomycosis
Cell Biology
Bronchoalveolar Lavage Fluid
Biopsy
Lung
HIV Infections
Fungi
HIV

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Immunology
  • Microbiology
  • Parasitology
  • Virology
  • Immunology and Allergy
  • Infectious Diseases

Cite this

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title = "Bronchoscopic diagnosis of pulmonary coccidioidomycosis comparison of cytology, culture, and transbronchial biopsy",
abstract = "The results of all fiberoptic bronchoscopic examinations that detected Coccidioides immitis at two medical centers in an area endemic for coccidioidomycosis were retrospectively reviewed. Coccidioides immitis was detected by cytologic examination of fluid from either bronchial wash or bronchoalveolar lavage (BAL) fluid in eight (42{\%}) of 19 HIV-infected patients and in 11 (31{\%}) of 35 patients without HIV infection (P = 0.627). In all cases, the fluid samples grew C. immitis. The median time to positive identification of the fungus was 25 days. Preliminary identification of C. immitis, however, took a median of 3.5 days (range, 2-9 days) in 10 patients on whom these data were available. Transbronchial biopsy was performed simultaneously in eight cases, and C. immitis was identified by morphologic examination in all eight. These results indicate that cytologic examination of bronchial wash or BAL fluid from patients with and without HIV infection is diagnostic in less than half of cases of pulmonary coccidioidomycosis. Culture of the same fluid appears to be more sensitive than cytologic examination in establishing this diagnosis.",
author = "DiTomasso, {John P.} and Ampel, {Neil M.} and Sobonya, {Richard E} and Bloom, {John W}",
year = "1994",
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AU - Bloom, John W

PY - 1994

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N2 - The results of all fiberoptic bronchoscopic examinations that detected Coccidioides immitis at two medical centers in an area endemic for coccidioidomycosis were retrospectively reviewed. Coccidioides immitis was detected by cytologic examination of fluid from either bronchial wash or bronchoalveolar lavage (BAL) fluid in eight (42%) of 19 HIV-infected patients and in 11 (31%) of 35 patients without HIV infection (P = 0.627). In all cases, the fluid samples grew C. immitis. The median time to positive identification of the fungus was 25 days. Preliminary identification of C. immitis, however, took a median of 3.5 days (range, 2-9 days) in 10 patients on whom these data were available. Transbronchial biopsy was performed simultaneously in eight cases, and C. immitis was identified by morphologic examination in all eight. These results indicate that cytologic examination of bronchial wash or BAL fluid from patients with and without HIV infection is diagnostic in less than half of cases of pulmonary coccidioidomycosis. Culture of the same fluid appears to be more sensitive than cytologic examination in establishing this diagnosis.

AB - The results of all fiberoptic bronchoscopic examinations that detected Coccidioides immitis at two medical centers in an area endemic for coccidioidomycosis were retrospectively reviewed. Coccidioides immitis was detected by cytologic examination of fluid from either bronchial wash or bronchoalveolar lavage (BAL) fluid in eight (42%) of 19 HIV-infected patients and in 11 (31%) of 35 patients without HIV infection (P = 0.627). In all cases, the fluid samples grew C. immitis. The median time to positive identification of the fungus was 25 days. Preliminary identification of C. immitis, however, took a median of 3.5 days (range, 2-9 days) in 10 patients on whom these data were available. Transbronchial biopsy was performed simultaneously in eight cases, and C. immitis was identified by morphologic examination in all eight. These results indicate that cytologic examination of bronchial wash or BAL fluid from patients with and without HIV infection is diagnostic in less than half of cases of pulmonary coccidioidomycosis. Culture of the same fluid appears to be more sensitive than cytologic examination in establishing this diagnosis.

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