Role of Bronchoalveolar Lavage in the Diagnosis and Management of Pneumonia in Pediatric Patients Undergoing Hematopoietic Progenitor Transplantation: A Retrospective Study at the Pereira Rossell Hospital Center (2023-2024)
Annabelle Sánchez, Isabel Larre Borges, Gabriel Dapueto, Beatriz Paladino, Martín Ormachea, Magdalena Schelotto, Carolina Pagés, Miguela A Caniza, Fabiana Morosini, Mónica PujadasAbstract
Background
A hematopoietic stem cell transplant (HSCT) produces immunosuppression and predisposes patients to infections, including pneumonia, which is the most common and potentially the most serious. Bronchoalveolar lavage (BAL) in pneumonia offers the possibility of diagnosing the causative pathogens and guiding appropriate treatment.
Methods
Retrospective observational study in pediatric patients who underwent allogeneic HSCT between January 2023 and September 2024 at the Pediatric Hemato-Oncology Center of the Pereira Rossell Hospital and developed pneumonia (fever >38.3 °C and pulmonary radiological findings) requiring BAL. Data were collected from medical records and laboratory results. Statistical analysis included frequency distribution and percentages. All patients gave their informed consent for the research.
Results
We studied 26 patients who had allogeneic HSCT, 11 of them (42%) required one or more BAL procedures for the diagnosis of pneumonia, totaling 19 procedures. Most cases occurred in patients with leukemia (n=6, 32%) within the first 96 days after transplant (median 61 days). Fifty-eight percent (n = 11) of patients had a chest computed tomography (CT) scan before the BAL procedure, and CT showed abnormalities in 90%. The BAL results were diagnostic in 84% of the cases (n=16), secretions or mucosal obstruction were observed in 58% (n=11), pulmonary bleeding in 15% (n=3) and it was detected at least one pathogen in 74%. (n=14). Percentages for specific pathogens were calculated relative to these 14 cases; the most frequent pathogens were viral agents (n=14, 100%), with cytomegalovirus (CMV) being the most common (n=12, 86%). Identified viral co-pathogens included bocavirus (n=2, 14%), parainfluenza (n=3, 21%), SARS-CoV-2 (n=1, 7%), and influenza A-H3 (n=1, 7%). Two bacterial co-pathogens were Actinomyces sp. (n=1) and Klebsiella sp. (n=1). In 2 BAL, a fungal co-pathogen, Aspergillus fumigatus, was detected in the same patient. Detection of galactomannan antigen in BAL was positive in 8 of 19 BAL procedures (42%) (ODI >1); Serum galactomannan determination was performed in 6 patients, but all were negative (ODI ≤ 0.5). Based on the BAL findings, the treatment was changed in 9 patients (47%), mainly starting broad-spectrum antifungals. A new infectious diagnosis was identified in 42% (n=8) of bronchoscopies and BAL. All patients had respiratory symptoms, 70% required supplemental oxygen and 15% mechanical ventilation. 95% (n=18) had antibiotics for at least five days prior BAL. No adverse events were reported.
Conclusions
BAL in post-HSCT patients with pneumonia was critical for etiological diagnosis and guiding clinical management. This procedure proved to be safe, aligning with literature reports. Early identification of patients requiring BAL can lead to better outcomes in this vulnerable population.