Open lung biopsy for investigation of acute respiratory episodes in patients with HIV infection and AIDS.

BACKGROUND--Open lung biopsy (OLB) is rarely necessary for investigation of HIV positive patients with acute respiratory episodes because of the high yield from fibreoptic bronchoscopy with bronchoalveolar lavage (BAL). METHODS--A retrospective review of OLB in HIV positive patients admitted to a specialist inpatient unit with acute respiratory symptoms was carried out in order to define clinical indications, diagnostic yield, impact on management, complications and outcome. RESULTS--OLB was performed in 23 patients; 21 had undergone one or more bronchoscopies with BAL (5 also had negative results from transbronchial biopsy). Indications for OLB were: Group A, 15 patients thought clinically to have pneumocystis pneumonia but not responding to treatment; Group B, 4 patients with focal chest radiographic abnormalities; Group C, 4 patients with diffuse radiographic abnormalities and miscellaneous conditions. Preoperative PaO2 (on air) ranged from 4.4 to 14.5 (mean = 9.5) kPa. The results of OLB were in Group A 5 patients had non specific interstitial pneumonitis (NIP), 1 also had Kaposi's sarcoma, 4 had pneumocystis pneumonia (1 also had bronchiolitis obliterans organising pneumonia [BOOP]), 3 had Kaposi's sarcoma and 1 had BOOP and emphysema, 1 had pulmonary infarction and no infection and 1 had normal lung tissue. In Group B diagnoses were NIP, B cell lymphoma, occult alveolar haemorrhage and Pseudomonas aeruginosa pneumonia with BOOP; In Group C 2 patients had NIP and 2 had pneumocystis pneumonia (1 also had cytomegalovirus pneumonitis). All patients survived surgery and none required mechanical ventilation. OLB results significantly affected management; in Group A inappropriate treatment was discontinued in 11 patients found not to have pneumocystis pneumonia, and alternative therapy was begun in the 4 with pneumocystis and in Groups B and C 6 patients began specific therapy; unnecessary therapy was avoided in one and antimicrobial treatment was modified in one. CONCLUSIONS--Open lung biopsy in HIV positive patients with focal and diffuse radiographic abnormalities has a high diagnostic yield and low morbidity. This investigation should be considered in those with acute respiratory episodes and negative results from bronchoscopic investigations or who have contra-indications to this procedure.

[1]  R. Miller,et al.  Granulomatous Pneumocystis carinii pneumonia: DNA amplification studies on bronchoscopic alveolar lavage samples. , 1994, Journal of clinical pathology.

[2]  R. Miller,et al.  Histologically atypical Pneumocystis carinii pneumonia. , 1993, Thorax.

[3]  R. Miller,et al.  Bronchopulmonary Kaposi's sarcoma in patients with AIDS. , 1992, Thorax.

[4]  K. Kitada,et al.  [Detection of Pneumocystis carinii with DNA amplification]. , 1992, Nihon rinsho. Japanese journal of clinical medicine.

[5]  R. Miller,et al.  Occult alveolar haemorrhage in bronchopulmonary Kaposi's sarcoma. , 1992, Journal of clinical pathology.

[6]  R. Miller,et al.  Sputum induction for the diagnosis of pulmonary disease in HIV positive patients. , 1991, The Journal of infection.

[7]  R. Miller,et al.  DNA amplification on induced sputum samples for diagnosis of Pneumocystis carinii pneumonia , 1991, The Lancet.

[8]  R. Miller,et al.  Amplification of mitochondrial ribosomal RNA sequences from Pneumocystis carinii DNA of rat and human origin. , 1990, Molecular and biochemical parasitology.

[9]  R. Miller,et al.  Nebulised pentamidine as treatment for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. , 1989, Thorax.

[10]  R. Miller,et al.  Empirical treatment without bronchoscopy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. , 1989, Thorax.

[11]  R. Miller,et al.  Diagnosis of pulmonary disease in human immunodeficiency virus infection: role of transbronchial biopsy and bronchoalveolar lavage. , 1989, Thorax.

[12]  F. Ognibene,et al.  Nonspecific interstitial pneumonitis in patients with AIDS: radiologic features. , 1987, AJR. American journal of roentgenology.

[13]  J. Hopkin,et al.  CARDIORESPIRATORY ARREST AND AUTONOMIC NEUROPATHY IN AIDS , 1987, The Lancet.

[14]  F. Ognibene,et al.  Nonspecific interstitial pneumonitis: a common cause of pulmonary disease in the acquired immunodeficiency syndrome. , 1987, Annals of internal medicine.

[15]  C. Aranda,et al.  The role of open lung biopsy in patients with the acquired immunodeficiency syndrome. , 1987, Chest.

[16]  J. Touboul,et al.  Pulmonary Kaposi's sarcoma in patients with acquired immune deficiency syndrome: a clinicopathological study. , 1987, Thorax.

[17]  D. Stover,et al.  Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome. Clinical, radiographic, and pathologic manifestations. , 1986, The American journal of medicine.

[18]  M. Cash,et al.  Value of bronchoalveolar lavage in the diagnosis of pulmonary infection in acquired immune deficiency syndrome. , 1986, Thorax.

[19]  P. Goldstraw,et al.  Open lung biopsy in patients with diffuse pulmonary shadowing. , 1985, Thorax.

[20]  M. Dake,et al.  Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. , 1985, Annals of internal medicine.

[21]  E. Wagar,et al.  Use of the transbronchial biopsy for diagnosis of opportunistic pulmonary infections in acquired immunodeficiency syndrome (AIDS). , 1984, American journal of clinical pathology.

[22]  D. Maki,et al.  Lung biopsy in immunocompromised patients: One institution's experience and an approach to management of pulmonary disease in the compromised host , 1981, Cancer.

[23]  V. Devita,et al.  Pneumocystis Pneumonia: The Importance of Early Open Lung Biopsy , 1976, Annals of surgery.

[24]  R. Greenman,et al.  Lung biopsy in immunocompromised hosts. , 1975, The American journal of medicine.

[25]  N. Martini,et al.  Pneumocystis carinii pneumonia. Diagnosis by lung biopsy. , 1972, The American journal of medicine.