Fiberoptic bronchoscopy was performed as previously described.14–15
The patients gargled with a mouthwash with 1 to 3% povidone-iodine (Meiji Co; Tokyo, Japan) just before the examination. The bronchoscope was inserted through the mouth in patients who were not intubated. In all patients with AEP and in healthy subjects, the tip of the bronchoscope was wedged into a distal portion of a bronchus in the right middle lobe, and BAL was performed by instilling three 50-mL aliquots of a sterile saline solution through the bronchoscope. To obtain BALF from patients with CEP, the tip of the bronchoscope was wedged into the bronchus showing pulmonary infiltrates on a chest CT scan. Samples of BALF were taken for fungal, mycobacterial, viral, Legionella, and other bacterial cultures. Some of the fluids underwent cytocentrifugation, and the pellets were examined for cellular differentials with the use of May-Giemsa stain, and for microorganisms using Gram stain, acid-fast bacilli, and Groccot stain. At follow-up, after the conditions of four of six patients with AEP had improved, BAL was performed for the second time.