Öz

Objective: Bronchoalveolar lavage (BAL) is a widely used diagnostic tool for evaluating lower respiratory tract infections and pulmonary pathologies in children. BAL provides valuable diagnostic information and can significantly influence management strategies, particularly in patients with malignancy, immunodeficiency (ID), or critical illness. This study aimed to assess the diagnostic and therapeutic value of BAL in pulmonary fungal infections.

Material and Methods: This retrospective study analyzed BAL samples obtained by flexible fiberoptic bronchoscopy (FFB) between 2019 and 2024 in the Pediatric Pulmonology Department of a tertiary referral center. Among 668 patients who underwent FFB, those with BAL fungal culture, BAL Aspergillus DNA PCR, and BAL galactomannan antigen (GM) testing were included. Demographic, clinical, radiological, and bronchoscopic findings, as well as antifungal treatment modifications based on BAL results, were evaluated.

Results: BAL results from 668 patients were reviewed. Fungal culture was performed in 236 (35.3%), Aspergillus DNA PCR in 127 (19%), and GM in 121 (18.1%) patients. Among those tested for fungal culture, 58.9% were male, with a mean age of 7.0 years (±5.7). Fungal culture positivity was found in 26 (11%) patients: Candida
albicans (n=14), Aspergillus spp. (n=5), Candida
dubliniensis (n=3), Aspergillus fumigatus (n=3), and Penicillium spp. (n=1). Culture positivity was significantly higher in patients with malignancy (p=0.011). BAL Aspergillus DNA PCR was positive in two patients, and BAL GM in five. Based on BAL results, antifungal therapy was modified in seven patients.

Conclusion: BAL fungal culture, BAL GM, and Aspergillus PCR testing are valuable diagnostic tools for pulmonary fungal infections in children, especially those with malignancy or immunodeficiency (ID). The observed treatment modifications following BAL results emphasize their clinical importance not only in establishing diagnosis but also in guiding and optimizing antifungal therapy.

Anahtar Kelimeler: Aspergillus, candida , bronchoalveolar lavages , bronchoscopy , pulmonary fungal infections

Kaynakça

  1. Sureka N, Sharan S, Ahluwalia C, Ahuja S, Ranga S. Diagnostic utility of bronchoalveolar lavage in pulmonary disorders. Rev Esp Patol. 2025;58(3):100830. https://doi.org/10.1016/j.patol.2025.100830
  2. Maux JML, Silva HG, Silva META, et al. Use of bronchoalveolar lavage in the diagnosis of pulmonary diseases and its potential clinical-laboratory applications: a review. Braz J Biol. 2025;85:e292731. https://doi.org/10.1590/1519-6984.292731
  3. Meyer KC. Bronchoalveolar lavage as a diagnostic tool. Semin Respir Crit Care Med. 2007;28(5):546-60. https://doi.org/10.1055/s-2007-991527
  4. Davidson KR, Ha DM, Schwarz MI, Chan ED. Bronchoalveolar lavage as a diagnostic procedure: a review of known cellular and molecular findings in various lung diseases. J Thorac Dis. 2020;12(9):4991-5019. https://doi.org/10.21037/jtd-20-651
  5. Altınel E, Yaralı N, Işık P, et al. Evaluatıon of febrıle neutropenıa ın chıldren wıth acute leukemıa. Turk J Pediatr Dis. 2012;6(2):93-100.
  6. Choo R, Naser NSH, Nadkarni NV, Anantham D. Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. BMC Pulm Med. 2019;19(1):51. https://doi.org/10.1186/s12890-019-0801-2
  7. Baughman RP. Technical aspects of bronchoalveolar lavage: recommendations for a standard procedure. Semin Respir Crit Care Med. 2007;28(5):475-85. https://doi.org/10.1055/s-2007-991520
  8. Azoulay E, Mokart D, Rabbat A, et al. Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Crit Care Med. 2008;36(1):100-7. https://doi.org/10.1097/01.CCM.0000295590.33145.C4
  9. Rañó A, Agustí C, Jimenez P, et al. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures. Thorax. 2001;56(5):379-87. https://doi.org/10.1136/thorax.56.5.379
  10. Bada-Bosch I, Pérez-Egido L, García-Casillas MA, et al. Bronchoalveolar lavage usefulness in the pediatric population. Cir Pediatr. 2020;33(4):160-5.
  11. Bezdicek M, Lengerova M, Ricna D, et al. Rapid detection of fungal pathogens in bronchoalveolar lavage samples using panfungal PCR combined with high resolution melting analysis. Med Mycol. 2016;54(7):714-24. https://doi.org/10.1093/mmy/myw032
  12. Johnson DC, Chirumamilla SK, Paez AP. Respiratory Candida in Patients with Bronchitis, Mucus Plugging, and Atelectasis. Open Respir Med J. 2020;14:87-92. https://doi.org/10.2174/1874306402014010087
  13. Ayçiçek O, Pehlivanlar Küçük M, Koç İ, et al. Fungal culture results and clinical effects of bronchoscopy specimens. Tuberk Toraks. 2022;70(1):15-26. https://doi.org/10.5578/tt.20229903
  14. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42(10):1417-27. https://doi.org/10.1086/503427
  15. Espy MJ, Uhl JR, Sloan LM, et al. Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev. 2006;19(1):165-256. https://doi.org/10.1128/CMR.19.1.165-256.2006
  16. Torelli R, Sanguinetti M, Moody A, et al. Diagnosis of invasive aspergillosis by a commercial real-time PCR assay for Aspergillus DNA in bronchoalveolar lavage fluid samples from high-risk patients compared to a galactomannan enzyme immunoassay. J Clin Microbiol. 2011;49(12):4273-8. https://doi.org/10.1128/JCM.05026-11
  17. Kotby AA, Shaheen MA, Basim HH, et al. Diagnostic Bronchoalveolar Lavage (BAL) for Pulmonary Fungal Infections in Critically Ill Children. Journal of Bronchology 2008;15(1):p 4-10. https://doi.org/10.1097/LBR.0b013e3181608662
  18. Batra S, Li B, Underhill N, et al. Clinical utility of bronchoalveolar lavage and respiratory tract biopsies in diagnosis and management of suspected invasive respiratory fungal infections in children. Pediatr Blood Cancer. 2015;62(9):1579-86. https://doi.org/10.1002/pbc.25570
  19. Mutcali SI, Hussain N, Nematollahi S, et al. The performance of bronchoalveolar lavage Aspergillus PCR testing in solid organ transplant recipients with invasive pulmonary aspergillosis. Transpl Infect Dis. 2024;26(5):e14327. https://doi.org/10.1111/tid.14327
  20. Gao CA, Markov NS, Pickens C, et al. An Observational Cohort Study of Bronchoalveolar Lavage Fluid Galactomannan and Aspergillus Culture Positivity in Patients Requiring Mechanical Ventilation. Open Forum Infect Dis. 2025 15;12(3):ofaf090. https://doi.org/10.1093/ofid/ofaf090

Telif hakkı ve lisans

Telif hakkı © 2026 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Atıf Lisansı (CC BY) altında dağıtılmıştır.

Nasıl atıf yapılır

1.
Yetişgin H, Uytun S, Gençoğlu MY, Akyan Soydaş ŞS, Özkan Tabakçı S, Bilgiç I, et al. Bronchoalveolar lavage: A key tool in pulmonary fungal infection management. Turk J Pediatr Dis. 2026;Early View:1-5. https://doi.org/10.12956/TJPD.2025.1255