Bronchoscopy with Bronchoalveolar Lavage in Tuberculosis and Fungal Infections: Discussion (3)For diagnosing fungal infections, sputum culture appears to be inadequate in most cases. In the current series, we had no sputum smear-positive for fungus, although some patients were eventually culture-positive. The yield of bronchoscopy for fungal infections was significantly higher than noted by others, although several groups have reported on the use of bronchoscopy to diagnose fungal infections in smaller series.
The addition of BAL to bronchoscopy alone appears not to have influenced the diagnostic yield for our patients with M tuberculosis. This may be misleading, since the lavage process itself will increase the volume of the bronchial wash and often will induce cough productive of sputum during the bronchoscopy itself. Our results of the diagnostic yield of bronchoscopy (90 percent) are similar to other series which supplement their bronchoscopies with transbronchial biopsy. The transbronchial biopsy was the only positive specimen in only one patient in this series. The use of transbronchial biopsy increases the risk of bronchoscopy, and although it has a high diagnostic yield, it usually is not necessary even in patients with miliary tuberculosis. flovent inhaler
For patients with fungal infections, lavage also does not increase the yield of the procedure. However, for both M tuberculosis and fungal infections, our studies would suggest that both bronchial wash and lavage specimens, when available, should be sent for smear and culture.