Nuran ESEN, Aylin GÜLCÜ, Zeynep GÜLAY, Mine YÜCESOY, Arif Hikmet ÇIMRIN, Can SEVİNÇ, Eyüp Sabri UÇAN, Atila AKKOÇLU, Nuray KÖMÜS, Gülper ŞENER, Oya İTİL, Oğuz KILINÇ

Fırsatçı pulmoner infeksiyon ön tanısıyla yapılan bronkoalveoler lavajın mikrobiyolojik sonuçları

2001-2002 yıllarını kapsayan dönemde, fırsatçı pulmoner infeksiyon ön tanısı ile bronkoalveoler lavaj (BAL) yapılan, yaş ortalaması 51.4 ± 18.1 yıl olan, 33 (%53)’ü erkek, 29 (%47)’u kadın toplam 62 olgunun bakteriyolojik inceleme sonuçları değerlendirildi. Olguların 18 (%29)’inde hematolojik malignite, 13 (%21)’ünde solid organ tümörü, 31 (%50)’inde ise malign olmayan nedenlere bağlı immünsüpresyon söz konusu idi. Endoskopik olarak 11 (%18) olguda infeksiyon ile uyumlu bulgular, 2 (%3) olguda endobronşiyal lezyon, 2 (%3) olguda indirekt tümör bulguları saptanırken, 47 (%76) olguda ise fiberoptik bronkoskopik (FOB) bulgular normaldi. Aside dirençli basil (ARB) direkt bakısı 3 (%5) olguda pozitif bulundu. Dört (%6) olguda hem mikobakteriyel kültürde üreme hem de Mycobacterium tuberculosis-polimeraz zincir reaksiyonu (PCR)pozitifliği saptandı. Gram boyalı incelemede 14 (%23) olguda infeksiyon ile uyumlu bulgular vardı. On (%16) olgunun bakteriyolojik kültüründe tek etken, 7 (%11)’sinde ise birden fazla etken olmak üzere toplam 17 (%27) olguda üreme olduğu belirlendi. Tümü hematolojik maligniteli 3 (%5) olgunun fungal kültürlerinde üreme saptandı. Sonuçta dört olguda mikobakteriyel, 17 olguda bakteriyel, üç olguda da fungal olmak üzere toplam 24 (%39) olguda mikrobiyolojik olarak infeksiyon etkenine ulaşılmış oldu.

Microbiological results of bronchoalveolar lavage that was performed for opportunistic pulmonary infections

Between 2001-2002; in 62 cases, 33 (53%) male, 29 (47%) female, mean age 51.4 ± 18.1 years) bronchoalveolar lavage (BAL) was performed for diagnosis of opportunistic pulmonary infection and specimens were evaluated for results of microbiological examinations. There was hematological malignancy in 18 (29%) and solid organ malignancy in 13 (21%) cases. Thirty-one (50%) cases were immuncompromised for reasons other than malignancy. By endoscopic evaluation endobronchial lesion was seen in 2 (3%) cases, indirect tumor signs were seen in 2 (3%) cases and signs of infection were seen in 11 (18%) cases. Fortyseven (76%) cases were endoscopically normal. Acid-fast bacilli (AFB) direct examination was positive in 3 (5%) cases. In 4 (6%) cases mycobacterial culture was positive, Mycobacterium tuberculosis-polymerase chain reaction (PCR) was also positive in these four cases. Examination of Gram-stained smears for bacteria was associated with infection in 14 (23%) cases. Bacteriologic cultures were positive for single potential pathogen in 10 (16%) cases, and for mixed pathogens in 7 (11%) cases for a total number of 17 (27%). Fungal cultures were positive in 3 (5%) cases all of which had hematological malignancy. As a result in 24 (39%) cases microbiological agent of infection is determined: in four mycobacteria, in 17 bacteria other than mycobacteria and in three fungi.

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