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Factors limiting the utility of bronchoalveolar lavage in the diagnosis of Covid-19

Deepak Aggarwal, Varinder Saini
European Respiratory Journal 2020; DOI: 10.1183/13993003.03116-2020
Deepak Aggarwal
Dept. of Pulmonary Medicine, Government Medical College & Hospital, Chandigarh, India
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Varinder Saini
Dept. of Pulmonary Medicine, Government Medical College & Hospital, Chandigarh, India
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Abstract

Bronchoalveolar lavage has a specific place in the diagnosis of Covid-19. The clinical performance of BAL rRt-PCR is dynamic in nature and depends on different clinical and demographic factors.

We read with interest study by Geri et al. [1] in which the authors have demonstrated a strong agreement between negative nasopharyngeal (NPs)/nasal (Ns) swab and bronchoalveolar lavage (BAL) real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) in the diagnosis of Covid-19 among hospitalised patients. The study findings contradicted earlier report [2] and suggested a limited utility of BAL. However, the results need to be interpreted comprehensively before drawing any conclusion.

In the present study, BAL was negative for SARS-CoV-2 by rRT-PCR in majority of cases that included 38 patients (48%) with strong clinical and radiological suspicion for Covid-19. This finding implies either a high false negative rate of BAL rRT-PCR or an alternate diagnosis. Hence, authors should give a detail account of the final diagnoses and treatment outcomes of the patients and correlate these with the rRT-PCR results. This will give a better picture of the clinical performance of rRT-PCR in both BAL and upper respiratory samples.

Clinical test performance of rRT-PCR (in BAL/Ns/NPs) is a dynamic parameter that depends not only on its analytic sensitivity but also on the pretest probability. The pretest probability may in turn depend on the SARS-CoV-2 exposure history, disease symptoms and local disease prevalence [3]. The unexpected low positivity seen with BAL rRT-PCR in the study despite high pretest probability might be due to delayed time of sampling and/or disease stage. All these factors should have been considered while comparing the diagnostic yield in the study

Bronchoalveolar lavage has a specific place in the diagnostic algorithm of Covid-19 and is usually performed in a patient with lower respiratory tract involvement and high clinical suspicion but negative Ns/NPs result. However, negative BAL results should be interpreted comprehensively in light of different clinical and demographic factors on a case-to-case basis.

Footnotes

  • Conflict of interest: Dr. AGGARWAL has nothing to disclose.

  • Conflict of interest: Dr. SAINI has nothing to disclose.

  • Received August 12, 2020.
  • Accepted August 20, 2020.
  • Copyright ©ERS 2020
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

References

  1. ↵
    1. Geri P,
    2. Salton F,
    3. Zuccatosta L, et al.
    Limited role for bronchoalveolar lavage to exclude Covid-19 after negative upper respiratory tract swabs: a multicenter study. Eur Respir J 2020: 2001733. doi:10.1183/13993003.01733-2020
  2. ↵
    1. Wang W,
    2. Xu Y,
    3. Gao R, et al.
    Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020; 323: 1843–1844.
    OpenUrlPubMed
  3. ↵
    1. Woloshin S,
    2. Patel N,
    3. Kesselheim AS
    . False Negative Tests for SARS-CoV-2 Infection - Challenges and Implications. N Engl J Med 2020; 383: e38. doi:10.1056/NEJMp2015897
    OpenUrl
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Factors limiting the utility of bronchoalveolar lavage in the diagnosis of Covid-19
Deepak Aggarwal, Varinder Saini
European Respiratory Journal Jan 2020, 2003116; DOI: 10.1183/13993003.03116-2020

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Factors limiting the utility of bronchoalveolar lavage in the diagnosis of Covid-19
Deepak Aggarwal, Varinder Saini
European Respiratory Journal Jan 2020, 2003116; DOI: 10.1183/13993003.03116-2020
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