Medical Microbiology A Tutorial
Q1) What is bronchoalveolar lavage fluid? How is it obtained? What is its value as a
Bronchoalveolar lavage is a diagnostic procedure of washing a sample of cells and
secretions from the alveolar and bronchial airspaces. It is performed by installing
commercial sterile 0.9% saline solution for intravenous use via a channel of a
fiberoptic bronchoscope, which has been wedged into a bronchus with a matching
diameter. The fluid is then immediately withdrawn. The instilled fluid fills the
airspaces distal to the tip of bronchoscope, replacing the air. A portion of the installed
volume remains to be absorbed or expectorated after the procedure. After withdrawal,
the fluid should be kept on ice until it is further processed.
A major clinical limitation for the utility of bronchoalveolar lavage is the large range
of normal values for each parameter, which makes BALF insensitive in detecting
disease. Furthermore, abnormalities in BALF are rarely specific for any of the
interstitial lung diseases. There is large interindividual variation which may not be
related to the disease, and the airspace cells and secretions may not reflect
interstitial processes. The removal of BALF may preferentially select, activate or
injure some cells, and the composition of the epithelial lining fluid (ELF) may
change during the bronchoalveolar lavage. (Davis 1994).
Q2) Which organisms can be positive on an acid-fast stain?
Corynebacterineae, Mycobacteriumand Nocardia.
Q3) Given his medical history, which organism is this likely to be? How does the
finding that the patient is HIV positive affect this decision?