Bronchial brush, wash; bronchoalveolar lavage microscopy and culture

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Item	Process
Specimen	All fluid collected from bronchial washes and lavages should be submitted for cytological (see Lower respiratory tract cytology) and microbiological examination (see a Sputum microscopy and culture).
Method	Smears made from brush specimens. Differential cell counts performed on lavage specimens. Gram stain for bacteria and fungi; DFA for viruses (eg, RSV, influenza virus), Legionella spp, Pneumocystis jiroveci; acid fast stains for mycobacteria. Nucleic acid detection after amplification for Legionella spp, Pneumocystis jiroveci, Mycoplasma pneumoniae, mycobacteria and some viruses. Aerobic culture on non-selective media; selective media if appropriate (eg, Legionella spp). Quantitative bacterial culture may be performed. Mycobacterial culture; prolonged culture for fungi.
Application	Investigation of bacterial, viral and fungal bronchopulmonary infections, alveolar proteinosis, inflammatory and fibrosing lung disorders. Lavage has a higher yield for Pneumocystis jiroveci than does brush or wash. Lavage is contraindicated in suspected tuberculosis.
Interpretation	See Sputum microscopy and culture.
Reference	Baselski VS and Wunderink RG. Clin Microbiol Rev 1994; 7: 533-558. Carroll KC. J Clin Microbiol 2002; 40: 3115-3120.