A critical evaluation of bronchoalveolar lavage. Criteria for identifying unsatisfactory specimens.

In a multicenter, city-wide study of the use of bronchoalveolar lavage for the evaluation of diffuse interstitial lung diseases, the occurrence of specimens unsuitable for analysis was evaluated. Using a standardized bronchoscopy technique, 26 physicians obtained 1,588 lavage specimens from 787 patients over a 52-month period. After transport to and processing in one laboratory using standardized procedures, all specimens were interpreted by one pathologist.

In vitro susceptibility of fungi to killing by neutrophil granulocytes discriminates between primary pathogenicity and opportunism.

Pathogenic fungi, according to their propensity to cause infection of apparently normal individuals, can be grouped into either primary pathogens (e.g., Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, and Sporothrix) or opportunists (e.

Differentiation of Cryptococcus neoformans serotypes by isoenzyme electrophoresis.

Cryptococcus neoformans has been divided into four serotypes by specific agglutination in immune rabbit sera. Based on mating characteristics of the perfect state and epidemiologic and biochemical differences, the serotypes have been divided into two major pairs. In an attempt to characterize the serotypes further, the authors studied 22 strains of C.

Activation of complement by pathogenic and nonpathogenic Entamoeba histolytica.

Previous studies had demonstrated that strains of Entamoeba histolytica isolated from patients with colitis or amebic liver abscess were resistant to complement-mediated killing, whereas strains from asymptomatic patients were readily lysed by non-immune serum. Both serum-sensitive and serum-resistant strains of E. histolytica depleted complement rapidly as assessed by CH50, C3, and C7, and C5-9 hemolytic activities.

Lung inflammation in scleroderma: clinical, radiographic, physiologic and cytopathological features.

Twenty-five patients with systemic sclerosis were studied by chest radiography, lung function, esophageal motility, gallium-67 (67Ga) lung scanning and bronchoalveolar lavage (BAL). Alveolar inflammation, as defined by an elevation of proportional BAL lymphocyte or neutrophil counts, or increased thoracic uptake of 67Ga was found in 16 patients. An NIH gallium index greater than 65 index units identified a subgroup of patients with a significantly higher proportional BAL lymphocyte count (13.

Protection against gram-negative bacteremia and endotoxemia with human monoclonal IgM antibodies.

Hybridomas producing human monoclonal IgM antibodies (mAbs) against bacterial lipopolysaccharide (LPS) were generated by fusion of B lymphocytes from sensitized human spleen with heteromyeloma cells. The splenocytes were from patients undergoing splenectomy during staging for Hodgkin disease after vaccination with the J5 mutant of Escherichia coli, which is deficient in O antigenic side chains. This deficiency exposes the core oligosaccharide, common to LPS of all Gram-negative bacteria.

Pulmonary disposition of moxalactam.

Moxalactam is a new synthetic oxa-beta-lactam antibiotic with a broad spectrum of activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It has proven clinical efficacy in pneumonia caused by a variety of infecting organisms. Therapeutic concentrations of moxalactam are achieved in most body tissues and fluids, including pleural fluid and sputum.

Assessment of drug disposition in the lung.

Airway disposition of drugs is assessed with either physiological changes in lung mechanics or nuclear scanning of the tagged medication. Several methods have been described for assessment of the pulmonary disposition of drugs delivered by routes other than the airways. These methods include tissue biopsy and sputum analysis of pooled secretions and tracheal washings.

An in vitro gallium-67 lung index for the evaluation of sarcoidosis.

In the evaluation of the active alveolitis of pulmonary sarcoidosis, both the proportional lymphocyte count obtained by bronchoalveolar lavage and state of activation of the alveolar macrophage by gallium scanning are required. We injected 6 mCi (200 MBq) of 67Ga intravenously on 24 occasions in 13 patients with biopsy-proved sarcoidosis. Forty-eight hours later, patients were scanned with a rectilinear scanner and the generated scintigrams were evaluated using the NIH index.

Specific cross-protective antigonococcal immunity in the murine genital tract.

Specific acquired immunity to gonococci was studied in systemically immunized mice, challenged with 10(7) gonococci by intrauterine inoculation. Protection after intraperitoneal immunization was monitored by vaginal cultures taken 24 h post-challenge, since events during the first 24 h postexposure to gonococci are crucial in determining the outcome of infection. Mice were protected against gonococcal challenge by two inoculations with either live or boiled gonococci given 4 weeks apart, whereas immunization with one inoculation did not protect against challenge 1 week later.

Killing of Aspergillus spores depends on the anatomical source of the macrophage.

To resolve the controversy over the capacity of macrophages to kill or inhibit germination of Aspergillus spores, we compared this function in peritoneal and alveolar macrophages. Alveolar macrophages from rabbits killed 82 to 90% and completely digested 72 to 82% of spores of Aspergillus fumigatus in 30 h. In contrast, peritoneal macrophages could not even inhibit the germination of ingested spores; more than 85% transformed into mycelia within 24 h.

Prednisone and methylprednisolone disposition in the lung.

To compare the penetrability of methylprednisolone into lung tissue with that of prednisone, blood and bronchoalveolar lavage (BAL) fluid levels of methylprednisolone and prednisone were measured in 17 patients with a variety of lung diseases. To correct for variations in the quantity of lung fluid obtained by BAL, steroid levels were expressed in relation to creatinine concentrations. The level of methylprednisolone penetration in the pulmonary parenchyma, expressed by the slope of the relation between blood and BAL fluid, was 0.

Pulmonary disposition of tobramycin.

Each antibiotic has a characteristic penetration into respiratory secretions, influenced by serum concentration, protein binding, transport systems, and the presence of infection. Whereas previous studies have used only bronchial secretions and blood, in the present study, blood, bronchial secretions, and bronchoalveolar lavage (BAL) fluid were analyzed for tobramycin levels. In 10 studies in 9 patients, serum levels were significantly related to BAL fluid levels (r = 0.

Bronchoalveolar lavage in asbestosis.

The interstitial lung disease associated with asbestosis is unique in that the etiological agent and its effects on the pulmonary parenchyma can be studied on a serial basis using bronchoalveolar lavage. In this way both disease activity and structural derangements can be assessed and used in the treatment of the affected individual. In this review, attention has been drawn to the cascade of inflammatory changes induced by asbestos fibers.

Differentiation of neisseriaceae by isoenzyme electrophoresis.

Analysis of 71 strains of Neisseriaceae by starch-gel electrophoresis of hexokinase, phosphoglucomutase, glucose phosphate isomerase, and L-malate-nicotinamide adenine dinucleotide phosphate oxidoreductase showed that all gonococci and all memingococci have a characteristic hexokinase isoenzyme that is specific for each species and clearly distinguishes meningococci and gonococci from each other and from other species of Neisseriaceae. Strains of gonococci that were transformed into maltose utilizers by DNA from Neisseria lactamica and Neisseria meningitidis showed no change in the isoenzymes so that they could still be differentiated from meningococci and other Neisseriaceae by isoenzyme electrophoresis. In view of the limited sensitivity and specificity of conventional tests for the identification of gonococci and the possibility that gonococci may be transformed into maltose utilizers by DNA from normal throat flora, electrophoresis of hexokinase isoenzymes should be useful for the precise laboratory identification of the pathogenic neisseriae, especially those from atypical sites and those giving indeterminate reactions.

Ineffectiveness of single-dose human antiserum to core glycolipid (E. coli J5) for prophylaxis of bacteremic, gram-negative infections in patients with prolonged neutropenia.

It has been recently established that serum from human volunteers immunized with E. coli J5 vaccine prevents death of patients with gram-negative shock. The present study addressed the question whether the prophylactic administration of a similar amount of J5 antiserum could protect neutropenic patients from acquiring gram-negative infections.

Resistance to lysis by human serum of pathogenic Entamoeba histolytica.

A comparison was made of susceptibility to lysis by human sera among five non-pathogenic and 11 pathogenic strains of Entamoeba histolytica already characterized into zymodemes. The nonpathogenic strains were found to be uniformly susceptible to lysis. Nine of 11 pathogenic strains, including five strains isolated from liver abscesses, were found to be resistant to lysis by serum under identical conditions.