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Summary
Fibreoptic bronchoscopy was performed in 43 of 52 consecutive patients with opportunistic
pneumonia in the acquired immune deficiency syndrome (AIDS). The 15 patients in whom
a likely pathogen was not found by bronchoscopy (including the nine not having the
procedure) were treated for Pneumocystis carinii pneumonia (PCP) alone and all responded. In 11 of these a diagnosis of AIDS was confirmed
because of an alternative opportunistic infection within 6 months.
PCP was confirmed in 38 of the 52 patients and cytomegalovirus (CMV) was isolated
from 15 patients. The lower the partial pressure of arterial oxygen (Pa02) on admission the more likely was a pathogen to be found by bronchoscopy.
The admission Pa02 while the patient was breathing room air was the single most reliable prognostic
indicator. The mean PaO2 for survivors was 9·6 kPa and 6·7 kPa for non-survivors (P < 0·01 Student's t-test), with 50% mortality for patients with a PaO2 of less than 8 kPa on admission.
Temperature and pulse rate were sensitive indicators of response to treatment, obviating
the need for frequent arterial gas measurements and chest radiography.
Our findings suggest that although fibreoptic bronchoscopy contributed little to the
treatment and final outcome of the infection, it identified the causative pathogen
in most patients.
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Article info
Publication history
Accepted:
August 22,
1988
Identification
Copyright
© 1989 The British Society for the Study of Infection. Published by Elsevier Inc.
