Bronchial brush, wash; bronchoalveolar lavage microscopy and culture

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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).


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.


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.


See Sputum microscopy and culture.


Baselski VS and Wunderink RG. Clin Microbiol Rev 1994; 7: 533-558.

Carroll KC. J Clin Microbiol 2002; 40: 3115-3120.