Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:6.2.1.7 (BAL)
 1,977 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study investigated the significance of detecting cytomegalovirus in the bronchoalveolar lavage fluid of patients with human immunodeficiency virus infection. Bronchoscopy with BAL was performed on all patients. Lavage was examined for CMV by cytology, culture, and immunofluorescence. The lavage results were compared to clinical status at the time of bronchoscopy and the outcome of the respiratory event. Cytomegalovirus was detected in 51 percent of the BALs in the patients with HIV infection and 25 percent of the immunosuppressed patients without HIV. No association was found in the HIV infected patients between CMV and hypoxemia, abnormal chest roentgenogram, leukopenia, and increased mortality. As indicated by mortality, CMV did not significantly increase the severity of Pneumocystis carinii pneumonia. The study also suggested that CMV in BAL fluid reflected bronchopulmonary replication of the virus, and not contamination by virus in the blood. Cytomegalovirus does not appear to contribute directly to the pulmonary disease found in most patients with HIV infection.
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PMID:Cytomegalovirus in the bronchoalveolar lavage fluid of patients with AIDS. 215 78

The appropriate treatment of ventilator-associated pneumonia (VAP) must be based on accurate diagnosis, which can be done by microbiological examination of the samples obtained from the respiratory tract by nonbronchoscopic bronchoalveolar lavages (NB-BAL). This study was designed to determine the effectiveness of NB-BAL in diagnosing VAP in newborns. Two hundred and seven NB-BAL samples were obtained from 145 intubated neonates for microbiologic and cytologic evaluation of the distal airway. The NB-BAL samples were processed for microscopic quantification of the polymorphonuclear cells (PMN) containing intracellular bacteria (ICB) and quantitative culture (positive threshold, 10(5) cfu/ml). VAP was defined as a new, progressive, or persistent (>24 hrs) infiltrate on the chest radiograph, with two or more of the following criteria: (a) macroscopically purulent tracheal secretions, (b) fever or hypothermia, (c) leukocytosis or leukopenia, and (d) worsening of respiratory status with a Pa O2/F IO2 ratio of <240. Colonization was defined as mechanical ventilation for more than seven days, no signs of infection, and isolation of the same bacteria species in two previously obtained NB-BAL samples. Of the 145 neonates, 40 (27.5%) were infected and 12 (8.3%) were colonized. Forty-four patients (30%) developed VAP according to diagnostic categories based on clinical and radiologic criteria. Forty newborns with VAP (90%) had positive NB-BAL culture. The sensitivity, specificity, and positive and negative predictive values of NB-BAL fluid culture for VAP diagnosis were 90%, 90%, 70%, and 97%, respectively. The percentage of ICB was significantly higher in newborns with VAP. The presence of ICB in 2% or more on Giemsa-stained smears corresponded to a sensitivity of 94%, specificity of 83%, positive predictive value of 94%, and negative predictive value of 83%. The sensitivity and specificity of combination of ICB and NB-BAL quantitative culture in diagnostic samples were 94% and 90%, respectively. The positive and negative predictive values were 71% and 98%. In our study, the presence of leukocytes in the NB-BAL fluid smear of infants with VAP was higher than that of the colonized babies (84%, 26%). This difference was statistically significant (p < 0.0001). The sensitivity and specificity of PMNs in NB-BAL fluid for the diagnosis were 86% and 75%, respectively, and the positive and negative predictive values were 89% and 69%. We conclude that NB-BAL lavage is well tolerated and clinically useful in mechanically ventilated newborns. These results suggest that NB-BAL fluid microscopic examination and cultures can offer a sensitive and specific means to diagnose VAP in newborns and may provide relevant information about the causative pathogens.
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PMID:Nonbronchoscopic bronchoalveolar lavage for diagnosing ventilator-associated pneumonia in newborns. 1717 64