Comparison of Acid-Fast Stain and Auramine Rhodamine Fluorescent Smear on Bronchoalveolar Lavage Specimens Submitted for Cytologic Examination

Abstract Objectives Testing of bronchoalveolar lavage specimens with acid-fast bacilli (AFB) stain is not routinely performed in many institutions. In 2017, we began performing AFB stain on all BAL specimens submitted for cytologic examination. Herein, we evaluate the diagnostic value of this test in comparison to the auramine rhodamine fluorescent stain performed in parallel by the microbiology laboratory for specimens also submitted for AFB culture. Methods We retrospectively reviewed all BAL specimens that were reported as culture positive for Mycobacteria spp. (n = 109) by our microbiology laboratory between 7/20/2017 and 12/30/2018. Of these, 84 (77.0%) specimens were concurrently submitted for cytologic examination and reviewed by a board-certified cytopathologist. Results Of the 84 culture-positive BAL specimens submitted for cytologic exam, only 2 cases were positive for acid-fast bacilli on cytologic examination with AFB stain, yielding a sensitivity of 2.38%. In comparison, 11 of those specimens were identified on auramine rhodamine fluorescent stain, yielding a sensitivity of 13.1%. Both cases identified by the AFB stain on cytology were also identified by auramine rhodamine stain in microbiology. These data indicate that AFB stain conducted in cytology is 81.2% less sensitive for detection of AFB when compared to auramine rhodamine stain. All cases identified on smear and AFB stain (n = 11) belonged to the Mycobacterium avium-intracellulare complex. Conclusion Our study results suggest that in a low-prevalence population, the use of AFB stain on BAL specimens sent for cytologic examination lacks sensitivity and is unnecessary if the same specimen is also sent for microbiologic culture and auramine rhodamine stain. The use of AFB stain on BAL specimens that were not sent for AFB culture is suboptimal but may identify AFB in specimens obtained from patients for whom mycobacterial infection is not in the differential and may be clinically insignificant.

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Epidemiology of Nontuberculous Mycobacterial Infection in Tuberculosis Suspects

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0095 ◽

2021 ◽

Author(s):

Parasmal Suresh ◽

Anil Kumar ◽

Raja Biswas ◽

Divya Vijayakumar ◽

Swathy Thulasidharan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Species Diversity ◽

Mycobacterial Infection ◽

Opportunistic Pathogens ◽

Appropriate Treatment ◽

Wide Range ◽

High Species Diversity ◽

Nontuberculous Mycobacterial Infection ◽

Low Prevalence ◽

Culture Positive

Nontuberculosis mycobacteria (NTM) are opportunistic pathogens that cause a wide range of illnesses. Here, the species distribution and prevalence of NTM infections in tuberculosis suspects was analyzed. A total of 7,073 specimens from pulmonary and extrapulmonary sites were analyzed, and 709 (10%) were found to be culture positive for mycobacteria. Of these, 85.2% were identified as Mycobacterium tuberculosis complex and 14.8% as NTM (65.7% rapid growers and 34.3% slow growers). Speciation of the NTM isolates (n = 69) identified 19 NTM species. M. abscessus (33.3%) and M. fortuitum (24.6%) were the most dominant NTM species isolated from the patients, followed by M. porcinum (5.8%) and M. parascrofulaceum (4.3%). We also report peritonitis caused by rapidly growing NTM among the patients undergoing continuous ambulatory peritoneal dialysis and a case of M. senegalense peritonitis. A low prevalence but high species diversity of NTM was detected in our study. The high species diversity of NTM necessitates the need to unequivocally identify mycobacterial isolates for appropriate treatment.

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Diagnostic value of bronchoalveolar lavage in patients with opportunistic and nonopportunistic bacterial pneumonia

Infection ◽

10.1007/bf01712447 ◽

1993 ◽

Vol 21 (5) ◽

pp. 291-296 ◽

Cited By ~ 11

Author(s):

K. Dalhoff ◽

J. Braun ◽

R. Lipp ◽

K. -J. Wießmann ◽

H. Hollandt ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Bacterial Pneumonia ◽

Diagnostic Value

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Evaluation of diagnostic value of four tumor markers in bronchoalveolar lavage fluid of peripheral lung cancer

Asia-Pacific Journal of Clinical Oncology ◽

10.1111/ajco.12066 ◽

2013 ◽

Vol 10 (2) ◽

pp. 141-148 ◽

Cited By ~ 6

Author(s):

Jian Li ◽

Ping Chen ◽

Chao-Ming Mao ◽

Xing-Ping Tang ◽

Li-Rong Zhu

Keyword(s):

Lung Cancer ◽

Bronchoalveolar Lavage ◽

Tumor Markers ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Diagnostic Value ◽

Peripheral Lung Cancer ◽

Peripheral Lung

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Diagnostic Value of Bronchoalveolar Lavage in Suspected Pulmonary Tuberculosis

CHEST Journal ◽

10.1378/chest.93.2.329 ◽

1988 ◽

Vol 93 (2) ◽

pp. 329-332 ◽

Cited By ~ 63

Author(s):

J. de Gracia ◽

V. Curull ◽

R. Vidal ◽

A Riba ◽

R. Orriols ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Bronchoalveolar Lavage ◽

Diagnostic Value

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Blood Absolute T Cell Counts may Predict 2-Month Treatment Response in Patients with Pulmonary Tuberculosis

Disease Markers ◽

10.1155/2010/246451 ◽

2010 ◽

Vol 28 (6) ◽

pp. 343-352 ◽

Cited By ~ 3

Author(s):

Yung-Che Chen ◽

Huang-Chih Chang ◽

Chung-Jen Chen ◽

Shih-Feng Liu ◽

Chien-Hung Chin ◽

...

Keyword(s):

T Cells ◽

T Cell ◽

Treatment Response ◽

Lymphocyte Subsets ◽

Sputum Smear ◽

Slow Response ◽

Acid Fast Bacilli ◽

Cell Counts ◽

Bilateral Lung ◽

Culture Positive

Background and objective:Little is known about the usefulness of lymphocyte subsets as early predictors of anti-tuberculosis (TB) treatment response in immuno-competent patients.Methods:Among a total of 64 patients with culture positive pulmonary TB, 29 remained sputum smear/culture positive or had delayed resolution on CXR (slow responders (SR)), and 35 had sputum culture conversion to negative and rapid resolution on CXR (fast responders (FR)) after two months of anti-tuberculosis treatment. Clinical parameters and lymphocyte subsets were investigated.Results:A larger proportion of patients in the SR group had cavities on CXR, bilateral lung involvement, positive acid-fast bacilli stains, and complaint of cough at diagnosis than those in the FR group. Absolute counts of CD3+T cells (p= 0.016) and CD8+T cells (p= 0.012) at diagnosis were both significantly higher in the SR group. This trend was present throughout the 6-month treatment course. Absolute T cell counts (odds ratio (OR) 1.002, 95% confidence interval (CI) 1.0–1.004), positive sputum acid fast bacilli stain (OR 6.69, 95% CI 1.37–32.77) and bilateral lung involvemment on CXR (OR 13.114, 95% CI 1.87–92.14) at diagnosis were independent predictors for a slow response. Combining these three predictors, a prediction score (PS) could be calculated to display an optimal discrimination for slow response (area under the curve (AUC) = 0.855,p< 0.001) whereas absolute T cell counts yielded the highest discriminative value on an individual level (AUC = 0.676,p= 0.015).Conclusions:A higher T cell count at diagnosis in patients with TB may predict a slow response to two months of treatment. The calculation of a PS further increased predictive accuracy and performance.

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The perpetual enigma of bronchoalveolar lavage fluid lymphocytosis in chronic hypersensitivity pneumonitis: is it of diagnostic value?

European Respiratory Journal ◽

10.1183/13993003.01534-2020 ◽

2020 ◽

Vol 56 (2) ◽

pp. 2001534

Author(s):

Francesco Bonella ◽

Ulrich Costabel

Keyword(s):

Bronchoalveolar Lavage ◽

Hypersensitivity Pneumonitis ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Diagnostic Value ◽

Chronic Hypersensitivity Pneumonitis

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Diagnostic Value of Antibodies Against Pseudomonas aeruginosa in Bronchoalveolar Lavage Fluid After Lung Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2010.07.017 ◽

2010 ◽

Vol 42 (10) ◽

pp. 4415-4420 ◽

Cited By ~ 2

Author(s):

R. Vos ◽

B.M. Vanaudenaerde ◽

S.E. Verleden ◽

S.I. De Vleeschauwer ◽

A. Willems-Widyastuti ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Bronchoalveolar Lavage ◽

Lung Transplantation ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Diagnostic Value

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Diagnostic value of epidermal growth factor, cancer antigen 125, and cancer antigen 15-3 in bronchoalveolar lavage fluid of lung cancer

Current Oncology ◽

10.3747/co.24.3348 ◽

2017 ◽

Vol 24 (3) ◽

pp. 180 ◽

Cited By ~ 2

Author(s):

S. Sun ◽

Z. Chen ◽

C. Cao ◽

B. Wu ◽

B. Wang ◽

...

Keyword(s):

Lung Cancer ◽

Growth Factor ◽

Epidermal Growth Factor ◽

Bronchoalveolar Lavage ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Diagnostic Value ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Epidermal Growth

Aim In the present study, we assessed the diagnostic value of epidermal growth factor (egf) and cancer antigens 125 (ca125) and 15-3 (ca15-3) in bronchoalveolar lavage fluid (balf) of lung cancer from 79 enrolled patients with suspected lung cancer.Methods All patients underwent fibrescopic examination, during which balf samples were collected. Levels of egf, ca125, and ca15-3 were determined in balf using commercially available test kits.Results The results showed that levels of egf in balf were significantly higher in patients with lung cancer than in patients with benign diseases (p < 0.01); no significant differences for ca125 (p = 0.67) or ca15-3 (p = 0.43) in balf were observed between the lung cancer patients and the non-cancer control subjects. With a cut-off value of 27.22 pg/mL, egf showed a sensitivity of 63.6% and a specificity of 65.7% in predicting the malignant nature of pulmonary disease.Conclusions The study findings suggest that levels of egf are significantly increased in balf from patients with lung cancer than in balf from patients with benign disease. Detection of the level of egf in balf is proposed as a non-invasive test to identify patients at high risk for lung cancer.

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