Background and objective: Examination of sputum is the first diagnostic ste
p in the evaluation of HIV-infected patients with pulmonary complications.
We were interested in the indications and the diagnostic value of subsequen
t bronchoscopy and bronchoalveolar lavage (BAL) and especially the importan
ce of so-called atypical bacteria.
Patients and methods: We analysed 59 consecutive BALs performed in HIV posi
tive patients with pulmonary symptoms (48 men, 11 women, age 22-70 years, 3
6 in stage C). Culture for Legionella pneumophila and PCR analysis for Myco
plasma pneumoniae and Chlamydia pneumoniae were done in all cases.
Results: In 50 patients (85%) there was a clear indication for performing a
BAL because either an infectious agent could no be detected on sputum exam
ination (n=36), or the patient's sputum production was insufficient (n=14).
In 30 (60%) of these cases bronchoscopy and BAL were able to establish a d
iagnosis. The most frequent agent was Pneumocystis carinii (n=12). In contr
ast, BAL was able to establish coinfection in patients with positive sputum
samples in one case only. So-called atypical bacteria were not found.
Conclusion: In patients with a clear indication, especially a nondiagnostic
sputum examination, BAL plays an important role in the work-up of HIV-asso
ciated pulmonary disease. The search for so-called atypical bacteria yields