Diagnostic value of fiberoptic bronchoscopy in acquired immunodeficiency syndrome1
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.