The presence of viral isolates from bronchoalveolar lavage (BAL) fluid has been associated with poor outcomes in patients with respiratory failure. Their significance in non-viral pneumonia is unclear. In this study we reviewed our BAL data to determine patient characteristics and outcomes of patients with viral isolates.
We retrospectively reviewed all lavage results collected between December 2006 and August 2008 and identified patients with viral isolates. We recorded patient characteristics, radiographic results, and outcomes and compared them to patients with other microbiologic isolates.
138 lavage studies were done by the pulmonary service during this period. 14 patients had viral isolates, 7 had herpes simplex virus (HSV), and 7 had cytomegalovirus (CMV). 24 patients had bacterial isolates, 15 had fungal isolates, and 4 were positive for tuberculosis. All patients with HSV isolates had cough, 3 had dyspnea, and 3 had fever. Six had chronic medical conditions. Six patients had chest CT with ground glass opacities (86%). Three patients received acyclovir. One died and six were stable or improved. All patients with CMV isolates had cough, four had dyspnea, and four had fever. All were immunospressed; 4 had AIDS. X-rays/ Chest CTs were normal in two and revealed ground glass opacities in four (57%). One patient received anti CMV therapy and improved. The others improved without antiviral therapy. Patients with non-viral isolates were similar in demographics to those with viral isolates. Six patients had cough (5%). The chest CT findings were bilateral reticulonodular infiltrates or consolidation. Three patients had ground glass opacities on chest CT (7%).
All patients with HSV and CMV had cough compared to 5% of the other patients. Ground glass opacities on chest CT were much more common in patients with HSV and CMV compared to patients with other diagnoses. There was no correlation between antiviral therapy and outcome in HSV and CMV.
Cough is the most common symptom associated with viral isolates. Ground glass opacities on Chest CT is associated with viral isolates.
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