MCS bronchoalveolar lavage

Keywords: Bronchoalveolar lavage microscopy culture sensitivities, Bronchoalveolar lavage microscopy, Bronchoalveolar lavage culture, Bronchial brush wash

Specimen:

All fluid collected from bronchial washes and lavages should be submitted for cytological (see Lower respiratory tract cytology) and microbiological examination (see MCS sputum).

Method:

Smears made from brush specimens.

Differential cell counts performed on lavage specimens.

Gram stain for bacteria and fungi; DFA for viruses (eg, RSV, influenza virus), Legionella spp, Pneumocystis jiroveci; acid fast stains for mycobacteria.

Nucleic acid detection after amplification for Legionella spp, Pneumocystis jiroveci, Mycoplasma pneumoniae, mycobacteria and some viruses.

Aerobic culture on non-selective media; selective media if appropriate (eg, Legionella spp, Nocardia).

Quantitative bacterial culture may be performed.

Mycobacterial culture; prolonged culture for fungi.

Application:

Investigation of bacterial, viral and fungal bronchopulmonary infections, alveolar proteinosis, inflammatory and fibrosing lung disorders.

Lavage has a higher yield for Pneumocystis jiroveci than does brush or wash.

Lavage is contraindicated in suspected tuberculosis.

Interpretation:

See MCS sputum.

Reference:

Baselski VS et al. Clin Microbiol Rev. 1994; 7: 533-558.

Carroll KC. J Clin Microbiol. 2002; 40: 3115-3120.