Diagnostic value of fiberoptic bronchoscopy in acquired immunodeficiency syndrome1

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Diagnostic results of flexible fiberoptic bronchoscopy done as the first invasive procedure were evaluated in 50 patients considered to have the acquired immunodeficiency syndrome (AIDS). Five patients (10%) had nondiagnostic bronchoscopic examinations and were thought to have the pre-AIDS form of the disease, since Pneumocystis carinii pneumonia (PCP) was diagnosed an average of 4.5 months later. Bronchoscopy revealed pathogens in 87% of the remaining 45 patients with AIDS and showed false-negative results in 13%. Thirty-eight patients (84%) had PCP diagnosed on their first bronchoscopic examination. Transbronchial lung biopsy and transbronchial lung biopsy with bronchoalveolar lavage had high yields for PCP (94% and 95% respectively). Lavage alone had a lower yield (63%). Although 69 different bronchoscopy specimens were sent for mycobacterial smear and culture, only two patients were found to have mycobacteriosis (one M tuberculosis, one M avium-intracellulare). Fiberoptic bronchoscopy was found to be a safe, high-yield first procedure in AIDS patients, especially for PCP. Mycobacterial infection did not appear to be a common infection in AIDS at presentation, and the authors recommend transbronchial lung biopsy and bronchoalveolar lavage be done earlier in the diagnostic evaluation of patients considered to have AIDS.