SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

Filippo Patrucco, Carlo Albera, Michela Bellocchia, Valentina Foci, Francesco Gavelli, Luigi Mario Castello, Mattia Bellan, Pier Paolo Sainaghi, Chiara Airoldi, Piero Emilio Balbo, Paolo Solidoro, Filippo Patrucco, Carlo Albera, Michela Bellocchia, Valentina Foci, Francesco Gavelli, Luigi Mario Castello, Mattia Bellan, Pier Paolo Sainaghi, Chiara Airoldi, Piero Emilio Balbo, Paolo Solidoro

Abstract

Background: Bronchoscopy with bronchoalveolar lavage (BAL) during the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic should be reserved to a limited number of clinical indications. The yield of BAL for the diagnosis of suspected or confirmed pulmonary SARS-CoV-2 infection is still unknown.

Objectives: We aimed to evaluate the diagnostic ratio of BAL in detecting SARS-CoV-2 pulmonary infection in patients undergoing bronchoscopy for different indications as well as describe the clinical, radiological, and endoscopic characteristics of patients with SARS-CoV-2 on BAL.

Method: We conducted a multicenter retrospective study including all patients who underwent bronchoscopy for the detection of SARS-CoV-2 on BAL. Clinical, computed tomography (CT), endoscopic, and microbiologic data were gathered from March 16th to May 27th, 2020.

Results: 131 patients were included. Bronchoscopy was performed for suspected SARS-CoV-2 infection (65.5%), alternative diagnosis (12.9%), suspected superinfections (19.8%), and lung atelectasis (1.5%). SARS-CoV-2 was isolated on BAL 43 times (32.8%) and the highest isolation rate was in patients with suspected SARS-CoV-2 infection (74.4%); 76% of positive patients had a double-negative nasopharyngeal swab. Peripheral, posterior and multilobar CT opacities were more frequent in SARS-CoV-2 patients, and the number of CT findings was higher in positive patients, particularly those with suspected SARS-CoV-2 infection. We recorded a progressive reduction of SARS-CoV-2 isolation during the observation period.

Conclusions: In our centers, the rate of detection of SARS-CoV-2 on BAL in patients with suspected infection was 37.2%. The agreement of BAL with nasopharyngeal swabs was high; CT alterations could predict the pretest probability of SARS-CoV-2 infection, but suspicion of viral infection should be always considered.

Keywords: Bronchoalveolar lavage; Bronchoscopy; COVID-19; SARS-CoV-2.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2020 S. Karger AG, Basel.

Figures

Fig. 1
Fig. 1
Mean number of CT characteristics in different indications for bronchoscopy.
Fig. 2
Fig. 2
Proportion of SARS-CoV-2 isolation during the observation period divided into intervals of 14 days.
Fig. 3
Fig. 3
Proportion of SARS-CoV-2 isolation and the detection of other indications during the observation period divided into intervals of 14 days.

References

    1. Luo F, Darwiche K, Singh S, Torrego A, Steinfort DP, Gasparini S, et al. Performing Bronchoscopy in Times of the COVID-19 Pandemic: Practice Statement from an International Expert Panel. Respiration. 2020;99((5)):417–22.
    1. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020 Jan;25((3)):2000045.
    1. Woloshin S, Patel N, Kesselheim AS. False Negative Tests for SARS-CoV-2 Infection - Challenges and Implications. N Engl J Med. 2020 Aug;383((6)):e38.
    1. Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, et al. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT? Eur J Radiol. 2020 May;126:108961.
    1. Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology. 2020 Jun;25((6)):574–7.
    1. Wahidi MM, Lamb C, Murgu S, Musani A, Shojaee S, Sachdeva A, et al. American Association for Bronchology and Interventional Pulmonology (AABIP) Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients With Suspected or Confirmed COVID-19 Infection. J Bronchology Interv Pulmonol. 2020 Oct;27((4)):e52–4.
    1. Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F, Eapen G, et al. The Use of Bronchoscopy during the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. Chest. 2020. DOI: org/10.1016/j.chest.2020.04.036.
    1. Torrego A, Pajares V, Fernández-Arias C, Vera P, Mancebo J. Bronchoscopy in COVID-19 Patients With Invasive Mechanical Ventilation: A Center Experience. Am J Respir Crit Care Med. 2020 Jul;202((2)):284–7.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61((4)):344–9.
    1. Ministero della salute Covid-19 - Situazione in Italia. [cited 2020 June 08] Available from: .
    1. Moro M, Vigezzi GP, Capraro M, Biancardi A, Nizzero P, Signorelli C, et al. 2019-novel coronavirus survey: knowledge and attitudes of hospital staff of a large Italian teaching hospital. Acta Biomed. 2020 Apr;91(3-S):29–34.
    1. Di Lorenzo G, Di Trolio R. Coronavirus Disease (COVID-19) in Italy: Analysis of Risk Factors and Proposed Remedial Measures. Front Med (Lausanne) 2020 Apr;7:140.
    1. Rosenbaum L. Facing Covid-19 in Italy - Ethics, Logistics, and Therapeutics on the Epidemic's Front Line. N Engl J Med. 2020 May;382((20)):1873–5.
    1. Garbino J, Soccal PM, Aubert JD, Rochat T, Meylan P, Thomas Y, et al. Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults. Thorax. 2009 May;64((5)):399–404.
    1. Oren I, Hardak E, Zuckerman T, Geffen Y, Hoffman R, Yigla M, et al. Does molecular analysis increase the efficacy of bronchoalveolar lavage in the diagnosis and management of respiratory infections in hemato-oncological patients? Int J Infect Dis. 2016 Sep;50:48–53.
    1. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020 May;323((18)):1843–4.
    1. Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. Ann Intern Med. 2020 Aug;173((4)):262–7.
    1. Geri P, Salton F, Zuccatosta L, Tamburrini M, Biolo M, Busca A, et al. Limited role for bronchoalveolar lavage to exclude Covid-19 after negative upper respiratory tract swabs: a multicenter study. Eur Respir J. 2020 Aug;56((4)):2001733.
    1. Pogatchnik BP, Swenson KE, Sharifi H, Bedi H, Berry GJ, Guo HH. Radiology-pathology Correlation in Recovered COVID-19, Demonstrating Organizing Pneumonia. Am J Respir Crit Care Med. 2020 Jul;202((4)):598–9.
    1. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging. 2020 Jul;35((4)):219–27.
    1. Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stöger L, Beenen L, et al. COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society CO-RADS − A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation. Radiology. 2020 Aug;296((2)):E97–104.
    1. Ora J, Puxeddu E, Cavalli F, Giorgino FM, Girolami A, Chiocchi M, et al. Does bronchoscopy help the diagnosis in COVID-19 infection? Eur Respir J. 2020 Aug;56((2)):2001619.

Source: PubMed

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