scholarly journals SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

Respiration ◽  
2020 ◽  
pp. 1-9
Author(s):  
Filippo Patrucco ◽  
Carlo Albera ◽  
Michela Bellocchia ◽  
Valentina Foci ◽  
Francesco Gavelli ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Pulmonary Infection ◽  
Nasopharyngeal Swab ◽  
Double Negative ◽  
Progressive Reduction ◽  
Isolation Rate ◽  
Diagnostic Ratio ◽  
Suspected Infection ◽  
Endoscopic Characteristics ◽  
Observation Period

<b><i>Background:</i></b> Bronchoscopy with bronchoalveolar lavage (BAL) during the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic should be reserved to a limited number of clinical indications. The yield of BAL for the diagnosis of suspected or confirmed pulmonary SARS-CoV-2 infection is still unknown. <b><i>Objectives:</i></b> We aimed to evaluate the diagnostic ratio of BAL in detecting SARS-CoV-2 pulmonary infection in patients undergoing bronchoscopy for different indications as well as describe the clinical, radiological, and endoscopic characteristics of patients with SARS-CoV-2 on BAL. <b><i>Method:</i></b> We conducted a multicenter retrospective study including all patients who underwent bronchoscopy for the detection of SARS-CoV-2 on BAL. Clinical, computed tomography (CT), endoscopic, and microbiologic data were gathered from March 16th to May 27th, 2020. <b><i>Results:</i></b> 131 patients were included. Bronchoscopy was performed for suspected SARS-CoV-2 infection (65.5%), alternative diagnosis (12.9%), suspected superinfections (19.8%), and lung atelectasis (1.5%). SARS-CoV-2 was isolated on BAL 43 times (32.8%) and the highest isolation rate was in patients with suspected SARS-CoV-2 infection (74.4%); 76% of positive patients had a double-negative nasopharyngeal swab. Peripheral, posterior and multilobar CT opacities were more frequent in SARS-CoV-2 patients, and the number of CT findings was higher in positive patients, particularly those with suspected SARS-CoV-2 infection. We recorded a progressive reduction of SARS-CoV-2 isolation during the observation period. <b><i>Conclusions:</i></b> In our centers, the rate of detection of SARS-CoV-2 on BAL in patients with suspected infection was 37.2%. The agreement of BAL with nasopharyngeal swabs was high; CT alterations could predict the pretest probability of SARS-CoV-2 infection, but suspicion of viral infection should be always considered.

scholarly journals Pre-Procedural COVID-19 Nasopharyngeal Swab Has Good Concordance with Bronchoalveolar Lavage in Patients at Low Risk for Viral Infection

Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Catherine L. Oberg ◽  
Reza Ronaghi ◽  
Erik E. Folch ◽  
Colleen L. Channick ◽  
Tao He ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Low Risk ◽  
Lower Airway ◽  
Nasopharyngeal Swab ◽  
Symptom Screening ◽  
The World ◽  
Good Concordance ◽  
Sensitivity Specificity ◽  
Overall Reliability ◽  
Rule Out

<b><i>Background:</i></b> The coronavirus disease 2019 (COVID-19) pandemic has drastically affected hospital and operating room (OR) workflow around the world as well as trainee education. Many institutions have instituted mandatory preoperative SARS-CoV-2 PCR nasopharyngeal swab (NS) testing in patients who are low risk for COVID-19 prior to elective cases. This method, however, is challenging as the sensitivity, specificity, and overall reliability of testing remains unclear. <b><i>Objectives:</i></b> The objective of this study was to assess the concordance of a negative NS in low risk preoperative patients with lower airway bronchoalveolar lavage (BAL) specimens obtained from the same patients. <b><i>Methods:</i></b> We prospectively sent intraoperative lower airway BAL samples collected within 48 h of a negative mandatory preoperative NS for SARS-CoV-2 PCR testing. All adult patients undergoing a scheduled bronchoscopic procedure for any reason were enrolled, including elective and nonelective cases. <b><i>Results:</i></b> One-hundred eighty-nine patients were included. All BAL specimens were negative for SARS-CoV-2 indicative of 100% concordance between testing modalities. <b><i>Conclusions:</i></b> These results are promising and suggest that preoperative nasopharyngeal SARS-CoV-2 testing provides adequate screening to rule out active COVID-19 infection prior to OR cases in a population characterized as low risk by negative symptom screening. This information can be used for both pre-procedural screening and when reintroducing trainees into the workforce.

scholarly journals Clinical and Endoscopic Characteristics of GERD in Obese Patients

2021 ◽  
Vol 17 (4) ◽  
pp. 12-20
Author(s):  
I.V. Mayev ◽  
◽  
I.G. Bakulin ◽  
N.V. Bakulina ◽  
S.V. Tikhonov ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Reflux Disease ◽  
Negative Impact ◽  
Erosive Esophagitis ◽  
Suppressive Therapy ◽  
Therapeutic Approaches ◽  
Endoscopic Remission ◽  
Significant Negative Impact ◽  
Endoscopic Characteristics ◽  
Observation Period

Relevance. Obesity and gastroesophageal reflux disease (GERD) – diseases of the XXI century. Obesity is a risk factor for GERD, and has significant negative impact on its course, and causes the ineffectiveness of standard therapeutic approaches. Material and methods. The study involved 1,433 patients treated with proton pump inhibitors (PPIs) for non-erosive reflux disease (NERD) or erosive esophagitis (EE). The observation period was two months and included three visits with a four-week interval. Special attention was paid to the influence of overweight (body mass index (BMI) > 25 kg/m2) and abdominal obesity (waist circumference (WC) in men more than 94 cm, in women − more than 80 cm) on the course of GERD and the effectiveness of acid-suppressive therapy. Results. NERD was diagnosed in 618 (48.1%) patients, EE – in 614 (47.8%) patients. Overweight (BMI > 25 kg/m2) was detected in 901 (62.7%) patients, obesity (BMI > 30 kg/m2) – in 284 (19.9%) patients. Abdominal obesity was detected in 380 (56%) women and 193 (39%) men. Patients with BMI of 25 kg/m2 and abdominal obesity had more pronounced symptoms according to the results of the GERD Q questionnaire. Patients with NERD and EE did not differ in BMI and WC. The effectiveness of PPI therapy by the fourth week did not depend on BMI and WС, but patients without overweight and abdominal obesity were more likely to achieve clinical and endoscopic remission of the disease by the eighth week of therapy. The research participants received rabeprazole therapy in 96% of cases

Utility of bronchoalveolar lavage in the diagnosis of pulmonary infection in children with haematological malignancies

2012 ◽  
Vol 182 (2) ◽  
pp. 177-183 ◽  
Author(s):  
U. Rao ◽  
A. Piccin ◽  
A. Malone ◽  
K. O’Hanlon ◽  
F. Breatnach ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Pulmonary Infection ◽  
Haematological Malignancies

scholarly journals FilmArray Respiratory Panel Assay: Comparison of Nasopharyngeal Swabs and Bronchoalveolar Lavage Samples

2015 ◽  
Vol 53 (12) ◽  
pp. 3784-3787 ◽  
Author(s):  
Natalya Azadeh ◽  
Kenneth K. Sakata ◽  
Anjuli M. Brighton ◽  
Holenarasipur R. Vikram ◽  
Thomas E. Grys
Keyword(s):  
Bronchoalveolar Lavage ◽  
Respiratory Symptoms ◽  
Bacterial Pathogens ◽  
Nasopharyngeal Swab ◽  
Demographic Information ◽  
Lavage Sample

The FilmArray respiratory panel (FARP) reliably and rapidly identifies 17 viruses and 3 bacterial pathogens. A nasopharyngeal swab FARP (NP FARP) is performed for many patients with respiratory symptoms. For patients who are acutely ill or immunocompromised or fail to improve, a bronchoalveolar lavage sample FARP (BAL FARP) is performed in addition to the NP FARP. To date, no studies have compared the yield of a BAL FARP with that of an NP FARP. We retrospectively studied all patients who had a BAL FARP within 7 days after an NP FARP between June 2013 and May 2014. Demographic information, comorbidities, FARP results, and all microbiologic data from BAL fluid were collected. Eighty-six patients had a BAL FARP performed within 7 days (mean, 1.6; median, 1) after an NP FARP. Of these, 66 (77%) had concordant BAL and NP FARP results: 15 (23%) had the same pathogen identified from the NP and BAL FARPs, and 51 (77%) had concordant negative FARP results. In 18 of the 86 patients (21%), a pathogen was detected from the NP FARP; of these, 15 (83%) had a concordant match on a subsequent BAL FARP, and the remaining 3 had negative BAL FARPs. In 17 of the 86 patients (20%), pathogens were identified from the BAL FARPs that were not detected by the NP FARPs; of these, 16 (94%) had initial negative NP FARPs. The data suggest that once a pathogen is identified by an NP FARP, a subsequent BAL FARP is unlikely to add new microbiologic information. However, a BAL FARP may provide new, useful microbiologic information when performed within 7 days after a negative NP FARP.

scholarly journals Recurrence of COVID-19 related symptoms and viral detection in patient discharged after complete recovery and test negativization

2021 ◽  
Author(s):  
Chiara Vassallo ◽  
Francesca Pupo ◽  
Luca Marri ◽  
Chiara Schiavi ◽  
Francesca Giusti ◽  
...  
Keyword(s):  
Complete Recovery ◽  
Viral Reactivation ◽  
Nasopharyngeal Swab ◽  
Double Negative ◽  
The Novel ◽  
Lung Involvement ◽  
Rt Pcr ◽  
Pcr Assay ◽  
Virus Escape ◽  
Novel Coronavirus

Since the novel coronavirus disease 2019 (COVID-19) has declared pandemic, the possibility of recurrence of the disease after recovery has become a debated issue. We report a case of an 84-yearsold male patient who was admitted to our hospital for dyspnea and fever. Lab and clinical workout showed that he had COVID-19. After a full recovery of symptoms and a double negative nasopharyngeal swab of SARS-CoV-2 by RT-PCR assay, he was dismissed from the hospital. One month later, he developed again dyspnea and fever with lung involvement. Surprisingly, nasopharyngeal swab of SARS-CoV-2 was positive. Since he denied contacts with confirmed or suspected cases of COVID-19, he probably experienced a reactivation of a persistent infection. The failed eradication of the virus could depend on both virus’ escape mechanisms and dysfunctional immune response. Further studies are needed to confirm the hypothesis of viral reactivation and to identify signs of an incomplete clearance.

scholarly journals Diagnosis of COVID-19 by Bronchoalveolar Lavage after Two Negative Nasopharyngeal Swabs

2020 ◽  
Vol 15 (2) ◽  
pp. 5-7
Author(s):  
Victoria Chuen ◽  
Hosay Said ◽  
Jaymee Shell ◽  
William Plaxton ◽  
William Ciccotelli
Keyword(s):  
Bronchoalveolar Lavage ◽  
Lower Respiratory Tract ◽  
Sampling Technique ◽  
Clinical Findings ◽  
Nasopharyngeal Swab ◽  
False Negatives ◽  
Travel History ◽  
Hospital Infection Control ◽  
Control Procedures ◽  
High Degree

This case report highlights the diagnostic limitations of nasopharyngeal swabs in diagnosing COVID-19. This patient had a positive travel history, typical symptoms (fever, dry cough, dyspnea) and two negative nasopharyngeal swabs (NPS). He deteriorated clinically and required intubation. After intubation, bronchoalveolar lavage was used to sample the lower respiratory tract, which confirmed the diagnosis of COVID-19. This case demonstrates the diagnostic limitation of relying solely on nasopharyngeal swab PCR for the diagnosis of COVID-19. NPS tests may result in false negatives with incorrect sampling technique or if the sampling is done while upper tract viral load is low, such as very early or late during the illness course. During this pandemic, we posit that clinicians should maintain a high degree of suspicion based on supportive clinical findings despite negative PCR testing as this has implications for hospital infection control procedures. 

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