BRONCHOSCOPY AND THE DIAGNOSIS OF INVASIVE FUNGAL INFECTIONS IN IMMUNOCOMPROMISED HOSTS: A SINGLE-CENTER ONE-YEAR EXPERIENCE

TYPE: Late Breaking Abstract TOPIC: Chest Infections PURPOSE: The role of bronchoscopy in the diagnosis and management of pulmonary infections in immunocompromised patients remains controversial. There is a need to balance procedural risks and possibility of management-altering finding from bronchoscopy. A prospective registry was established in a tertiary university-affiliated hospital to assess the diagnostic yield and complication rates of bronchoscopy in immunocompromised patients. METHODS: Immunocompromised patients referred for evaluation of pulmonary infections and bronchoscopy were recruited into the registry. RESULTS: From 1st April 2021 to 31st March 2022, 45 patients with various immunosuppressive conditions with suspected pulmonary infections were recruited with informed consent. Of these, 23 patients had haematological conditions, including leukemia (11), lymphoma (6), myelodysplastic syndrome (3). 13 patients had solid organ cancers, 9 had autoimmune conditions, 3 had solid organ transplant and 3 were retroviral HIV. 9 patients were diagnosed with IFI. BAL Galactamannan of >0.5 had PPV and NPV of 83.3% and 91.9% for IFI respectively. Serum GM was sent for 5 patients but the results were all negative. Interestingly, 75.8% (22/29) with positive BAL fungal culture was not diagnosed with IFI. Radiologically, only 22.2% (2/9) patients with IFI had the typical “halo sign”. 88.9% (8/9) of patients presented with consolidation. CONCLUSIONS: In our single-centre experience, the role of BAL fungal cultures in the diagnosis of iFI is uncertain. The most common radiologic presentation of IFI is consolidation, and the halo sign was only present in 22.2% of patients with IFIs. CLINICAL IMPLICATIONS: Routinely sending bronchoalveolar lavage samples for fungal culture to aid with diagnosing IFI needs to be further examined DISCLOSURE: No significant relationships. KEYWORD: Bronchoscopy