Bronchoscopy in the diagnosis of pulmonary histoplasmosis.

Although histoplasmosis is the most common fungal infection of the lungs in the United States, there are no reports evaluating the efficacy of fiberoptic bronchoscopy in the diagnosis of this disease. We reviewed all cases of histoplasmosis diagnosed at our institution from 1972 to 1987. Of 469 patients, 71 underwent fiberoptic bronchoscopy and had culture/histologic proof of histoplasmosis established by fiberoptic bronchoscopy or other means. A diagnosis of pulmonary histoplasmosis could be made without thoracotomy in only 27. Among those not requiring thoracotomy, diagnosis of pulmonary histoplasmosis was confirmed by fiberoptic bronchoscopy and cultures of sputum, gastric washings, blood, bone marrow, and urine. In this subgroup, fiberoptic bronchoscopy was the only positive diagnostic method in eight of 27 patients. We conclude that fiberoptic bronchoscopy is a useful adjunct to other noninvasive measures yielding diagnostic material in most cases, except for solitary pulmonary nodule where it is rarely helpful.