Bronchoscopy specimens in adults with AIDS. Comparative yields of cytology, histology and culture for diagnosis of infectious agents.

Bronchoscopy specimens from 183 known/suspected acquired immunodeficiency syndrome patients were evaluated for pathogens. In each case, transbronchial biopsies were evaluated and bronchoalveolar lavage material was cultured for viruses, fungi and mycobacteria and examined cytologically. A specimen was considered positive for a pathogen if detected by any one of the methods (TBB or BALC or culture). BALC was more sensitive for Pneumocystis carinii than TBB (90 of 92 vs 67 of 80 cases). TBB and BALC had poor sensitivities for cytomegalovirus detection (six of 79 and ten of 91 cases, respectively): 80 of 91 CMV cases were detected by culture only. Nineteen of 26 MB cases were positive by culture only: BALC and TBB detected only three of 26 and five of 23 cases, respectively. Three cryptococcosis cases were detected by culture only. One coccidioidomycosis case was positive by BALC and culture. Culture and BALC in combination detected 212 of 216 all significant pathogens. We believe that TBB is not routinely necessary in AIDS-related bronchoscopies in the absence of suspicion of neoplasia.