Transthoracic Needle Aspiration in the Study of Pulmonary Infections in Patients With HIV

doi:10.1378/chest.106.3.697

Chest

Volume 106, Issue 3, September 1994, Pages 697-702

https://doi.org/10.1378/chest.106.3.697 Get rights and content

Study objective

To evaluate the safety and efficacy of transthoracic aspiration with an ultrathin needle in the microbiologic diagnosis of pulmonary infections in HIV-infected patients.

Design

Retrospective review of cases.

Setting

A 500-bed teaching hospital in Lleida, Spain.

Patients

Forty-five HIV-infected patients admitted between March 1989 and March 1993 with clinical and roentgenographic evidence of pulmonary infection and without contraindications for transthoracic needle aspiration (TNA).

Interventions

Forty-seven TNAs were performed in the emergency room (20) or during hospitalization (27). The TNA procedures were done without premedication and without fluoroscopic guidance. Specimens were processed using routine microbiologic and cytologic techniques; in addition, polymerase chain reaction (PCR) for Pneumocystis carinii was carried out since March 1992. Development of adverse effects was carefully evaluated.

Results

The TNA was effective in 29 (62 percent) out of 47 procedures. The diagnosis was obtained for 14 of 15 patients with P carinii pneumonia, 8 out of 14 patients with bacterial pneumonia, and 4 out of 12 patients with tuberculosis. Other pathogens recovered were Nocardia asteroides, Cryptococcus neoformans, Rhodococcus equi, and Mycobacterium avium No false-positive results were obtained. Pneumothorax developed in eight (17 percent) procedures, but only one procedure resulted in a pleural drainage; the incidence of other adverse effects was low and clinically irrelevant.

Conclusion

Our study suggests that TNA can be a useful technique in establishing the etiologic diagnosis of pulmonary infections in HIV-infected patients, with a good sensitivity, high specificity, and relatively low incidence of serious complications, with TNA appearing as a reliable alternative to more uncomfortable methods.

Section snippets

Methods

We have reviewed the records of all HIV-infected patients with pulmonary infection undergoing TNA at Arnau de Vilanova Hospital, Lleida, Catalonia, Spain, over 4-years (March 1989 to March 1993). Patients met the following criteria: (1) at least two clinical manifestations of respiratory infection (cough, fever, purulent sputum, pleuritic chest pain, or dyspnea); and (2) presence of chest roentgenographic abnormalities (focal or diffuse infiltrate and/or cavitation). Informed consent was

Results

Forty-five HIV-infected patients with clinical and roentgenographic evidence of pulmonary infection were studied. Their ages ranged from 23 to 66 years (mean age, 32 years), and 35 (77.7 percent) were men. Intravenous drug addiction was the most frequent risk factor that was identified in 39 (86.6 percent) patients, 5 (11.1 percent) became infected through heterosexual contact, and 1 (2.2 percent) was a homosexual man. Sixteen (35.5 percent) patients had a previous diagnosis of AIDS manifested

Discussion

The direct needle aspiration of a pulmonary lesion through the chest wall is an old technique used since the last decades of 19th century.¹⁶ Thereafter, numerous reports have appeared describing its application in the cytologic examination of lung nodules.¹⁷,¹⁸ The use of TNA in the study of pulmonary infections was developed poorly, but it was evaluated by Zavala and Schoell in 1981,¹⁹ and more recently by Manresa and Dorca,¹⁴ who reviewed in detail its methodology, efficacy, and safety.

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Lung nocardiosis in retroperitoneal fibrosis diagnosed by CT-guided fine needle aspiration
2007, Respiratory Medicine Extra
Computed tomography (CT)-guided fine needle aspiration (FNA) is a safe and effective procedure in the evaluation of undetermined pulmonary lesions. Most of the times FNA is a technique that leads to diagnosis in case of malignancies and benign tumors. Transthoracic FNA has a yield comparable to bronchoscopy for the diagnosis of infections and especially of rare opportunistic infections in immunosuppressed individuals. In this article we describe a case of Nocardia asteroides lung abscess that was diagnosed with CT-guided FNA, in a patient treated with corticosteroids for retroperitoneal fibrosis.
Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia
1999, American Journal of Medicine
PURPOSE: Although a wide variety of recognized pathogens can cause community-acquired pneumonia, in many patients the etiology remains unknown after routine diagnostic workup. The aim of this study was to identify the causal agent in these patients by obtaining lung aspirates with transthoracic needle aspiration.
SUBJECTS AND METHODS: During a 15-month period, all consecutive patients with community-acquired pneumonia who were eligible for transthoracic needle aspiration were enrolled in the study. In addition to conventional microbial methods (culture of blood and sputum, serologic studies), we performed cultures and genetic and antigen tests for common respiratory pathogens in lung aspirates.
RESULTS: The study group consisted of 109 patients. Conventional microbial studies identified an etiology in 54 patients (50%), including Mycoplasma pneumoniae in 19 patients, Chlamydia pneumoniae in 9 patients, and Streptococcus pneumoniae in 9 patients. Among the remaining 55 patients, study of the lung aspiration provided evidence of the causal agent in 36 (65%). In 4 additional patients with a single microbial diagnosis by conventional methods, the lung sample provided evidence of an additional microorganism. The new pathogens detected by lung aspiration were S. pneumoniae in 18 patients, Haemophilus influenzae in 6 patients, Pneumocystis carinii in 4 patients, and C. pneumoniae in 3 patients; other organisms were identified in 4 patients.
CONCLUSIONS: In our study, S. pneumoniae was the leading cause of community-acquired pneumonia, accounting for 25% of all cases, including about one-third of the cases the cause of which could not be ascertained with routine diagnostic methods.

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Clinical Investigations: HIV/InfectionsTransthoracic Needle Aspiration in the Study of Pulmonary Infections in Patients With HIV

Study objective

Design

Setting

Patients

Interventions

Results

Conclusion

Section snippets

Methods

Results

Discussion

Am J Med

Chest

Am J Med

Lancet

Chest

Chest

Lancet

Respir Med

Am J Med

Am J Med

Chest

Lancet

Chest

Chest

Tuberculosis and immunodeficiency syndrome.

J Infect Dis

Infection with Rhodococcus equi in AIDS.

N Engl J Med

Nocardiosis in patients with human immunodeficiency virus infection: report of 2 cases and review of the literature.

Medicine (Baltimore)

Disseminated infection with Mycobacterium kansasii in the acquired immnudeficiency syndrome.

Ann Intern Med

Pulmonary aspergillosis in the acquired immunodeficiency syndrome.

N Engl J Med

Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum.

Ann Intern Med

Diagnosis of Pneumocystis carinii pneumonia: improved detection in sputum with use of monoclonal antibodies.

N Engl J Med

Clinical Investigations: HIV/Infections
Transthoracic Needle Aspiration in the Study of Pulmonary Infections in Patients With HIV