The role of bronchoscopy in the diagnosis and treatment of pulmonary disease in HIV-infected patients

Aust N Z J Med. 1995 Apr;25(2):133-9. doi: 10.1111/j.1445-5994.1995.tb02825.x.


Background: Pulmonary disease is the most common reason for presentation and the major cause of death in HIV-infected patients. There has been an evolution in the optimal approach to the investigation of a pulmonary infiltrate in HIV-infected patients since the introduction of induced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP).

Aims: To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV-infected patients and to examine the effect of FFB on changes in therapy and survival.

Methods: The histories of all HIV-infected patients referred to Fairfield Hospital for FFB between January 1990 and June 1993 were examined retrospectively.

Results: Forty-two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n = 5), PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2), cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans pneumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa pneumonia (n = 1). TBB and BB did not provide a diagnosis for diseases not seen macroscopically at FFB or diagnosed by BAL. FFB findings altered diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases.

Conclusions: FFB together with BAL altered the working diagnosis and changed therapy in a significant number of patients. TBB and BB should not be routinely performed in all patients as these procedures are of limited value in this setting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • AIDS-Related Opportunistic Infections / pathology
  • Adult
  • Bacterial Infections / diagnosis
  • Biopsy
  • Bronchoscopy
  • Evaluation Studies as Topic
  • Female
  • Fiber Optic Technology
  • Humans
  • Lung / pathology
  • Lung Diseases, Fungal / diagnosis
  • Male
  • Middle Aged
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / pathology
  • Retrospective Studies
  • Therapeutic Irrigation