Bronchial brush, wash; bronchoalveolar lavage microscopy and culture
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Smears made from brush specimens.
Differential cell counts performed on lavage specimens.
Gram stain for bacteria and fungi; DFA for viruses (eg, RSV, influenza virus), Legionella spp, Pneumocystis jiroveci; acid fast stains for mycobacteria.
Nucleic acid detection after amplification for Legionella spp, Pneumocystis jiroveci, Mycoplasma pneumoniae, mycobacteria and some viruses.
Aerobic culture on non-selective media; selective media if appropriate (eg, Legionella spp).
Quantitative bacterial culture may be performed.
Mycobacterial culture; prolonged culture for fungi.
Investigation of bacterial, viral and fungal bronchopulmonary infections, alveolar proteinosis, inflammatory and fibrosing lung disorders.
Lavage has a higher yield for Pneumocystis jiroveci than does brush or wash.
Lavage is contraindicated in suspected tuberculosis.
Baselski VS and Wunderink RG. Clin Microbiol Rev 1994; 7: 533-558.
Carroll KC. J Clin Microbiol 2002; 40: 3115-3120.