Bronchoalveolar lavage-based COVID-19 testing in patients with cancer.
Bronchoalveolar lavage
Cancer
Coronavirus Disease 2019 (COVID-19)
Corticosteroids
Hematological malignancy
Immunocompromised
SARS-CoV-2
lymphopenia
Journal
Hematology/oncology and stem cell therapy
ISSN: 2589-0646
Titre abrégé: Hematol Oncol Stem Cell Ther
Pays: Saudi Arabia
ID NLM: 101468532
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
20
08
2020
accepted:
21
09
2020
pubmed:
16
10
2020
medline:
10
3
2021
entrez:
15
10
2020
Statut:
ppublish
Résumé
A few case reports in the setting of coronavirus disease 2019 (COVID-19) and multiplex polymerase chain reaction (PCR)-based assays for common respiratory pathogens have shown a higher yield of bronchoalveolar lavage (BAL) samples than upper airway specimens in immunocompromised patients. A retrospective study was conducted reviewing patients diagnosed with COVID-19 at the Medical College of Wisconsin (Milwaukee, WI, USA) between March 13, 2020 and June 11, 2020. All patients tested positive for SARS-CoV-2 via real-time reverse transcriptase PCR (RT-PCR), through a nasopharyngeal or a bronchoscopy specimen. During the study period, 53 bronchoscopy procedures were performed at the institution, of which five patients tested positive for COVID-19. Of the five patients, three underwent BAL testing based on high clinical suspicion for COVID-19 after the nasopharyngeal (NP) swab(s) was negative. All three patients had underlying cancers and had lymphopenia for a considerable duration prior to being diagnosed with COVID-19. Two patients had better outcomes that could be attributed to earlier BAL specimen testing resulting in timely medical intervention. This study underscores the need for early lower respiratory tract sampling, whenever possible, in patients with cancer and prolonged lymphopenia. High clinical suspicion ought to supersede false-negative NP reverse transcriptase-PCR as early bronchoscopic evaluation in cancer patients, who are either receiving active treatment or are immunosuppressed, can allow timely institution of efficacious treatment, enrollment into clinical trials, as well as effective infection control. In the apt clinical setting in patients with cancer, presumptive treatment may also be considered to minimize exposure to healthcare providers and proceduralists.
Sections du résumé
OBJECTIVE/BACKGROUND
OBJECTIVE
A few case reports in the setting of coronavirus disease 2019 (COVID-19) and multiplex polymerase chain reaction (PCR)-based assays for common respiratory pathogens have shown a higher yield of bronchoalveolar lavage (BAL) samples than upper airway specimens in immunocompromised patients.
METHODS
METHODS
A retrospective study was conducted reviewing patients diagnosed with COVID-19 at the Medical College of Wisconsin (Milwaukee, WI, USA) between March 13, 2020 and June 11, 2020. All patients tested positive for SARS-CoV-2 via real-time reverse transcriptase PCR (RT-PCR), through a nasopharyngeal or a bronchoscopy specimen.
RESULTS
RESULTS
During the study period, 53 bronchoscopy procedures were performed at the institution, of which five patients tested positive for COVID-19. Of the five patients, three underwent BAL testing based on high clinical suspicion for COVID-19 after the nasopharyngeal (NP) swab(s) was negative. All three patients had underlying cancers and had lymphopenia for a considerable duration prior to being diagnosed with COVID-19. Two patients had better outcomes that could be attributed to earlier BAL specimen testing resulting in timely medical intervention.
CONCLUSION
CONCLUSIONS
This study underscores the need for early lower respiratory tract sampling, whenever possible, in patients with cancer and prolonged lymphopenia. High clinical suspicion ought to supersede false-negative NP reverse transcriptase-PCR as early bronchoscopic evaluation in cancer patients, who are either receiving active treatment or are immunosuppressed, can allow timely institution of efficacious treatment, enrollment into clinical trials, as well as effective infection control. In the apt clinical setting in patients with cancer, presumptive treatment may also be considered to minimize exposure to healthcare providers and proceduralists.
Identifiants
pubmed: 33058787
pii: S1658-3876(20)30149-7
doi: 10.1016/j.hemonc.2020.09.002
pmc: PMC7543702
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
65-70Informations de copyright
Copyright © 2020 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Cancer Discov. 2020 Jun;10(6):783-791
pubmed: 32345594
BMC Res Notes. 2011 Apr 13;4:122
pubmed: 21489228
Clin Infect Dis. 2020 Jun 30;:
pubmed: 32603425
N Engl J Med. 2020 Aug 6;383(6):e38
pubmed: 32502334
Clin Infect Dis. 2020 Nov 19;71(16):2174-2179
pubmed: 32445579
Biol Blood Marrow Transplant. 2020 Sep;26(9):e241-e242
pubmed: 32589922
J Autoimmun. 2020 Aug;112:102463
pubmed: 32303424
Can Respir J. 2018 Apr 5;2018:2685723
pubmed: 29849830
Nature. 2020 Jul;583(7816):437-440
pubmed: 32434211
J Infect Dis. 2020 Jul 23;222(4):556-563
pubmed: 32526012
Front Immunol. 2020 Jun 05;11:1294
pubmed: 32582221
JAMA Oncol. 2020 Oct 1;6(10):1529-1530
pubmed: 32433719
Nature. 2020 May;581(7809):465-469
pubmed: 32235945
J Virol. 2005 Dec;79(23):14614-21
pubmed: 16282461
Lancet Respir Med. 2020 Jun;8(6):644-646
pubmed: 32437648
Mod Pathol. 2020 Nov;33(11):2104-2114
pubmed: 32561849