Bronchoalveolar lavage characteristics of pulmonary coccidioidomycosis

SESSION TITLE: Late-Breaking Insights in Pulmonary Medicine Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Coccidioidomycosis is an endemic fungal infection, predominately affecting the lungs and the pleural, but can also infect other organs e.g., skin and meninges. The diagnosis requires either histopathologic, culture-based, or serologic confirmation of clinical disease. Performance of bronchoalveolar lavage (BAL)-based testing has not been studied in a large scale. In this study we aimed to study clinical characteristics of patients with probable or definite diagnosis of pulmonary coccidioidomycosis (PC) along BAL-based testing. METHODS: The objectives of this study were to describe patients’ characteristics, BAL chemistry and cellular components, histopathological and microbiological BAL tests, and patients’ outcomes. We retrospectively identified all patients above the age of 18, with probable or definite diagnosis of PC, who underwent either inpatient or outpatient bronchoscopy for BAL between 2014 to 2022. We excluded patients under the age of 18, patients who had only positive IgM test by EIA, patients whose BAL sample couldn’t be analyzed, and patients who didn’t agree to share their medical information for research analytics. RESULTS: There were 6389 patients with a diagnosis PC (acute, chronic, or disseminated disease) that is either possible, probable, or definite disease. 560 patients (8.7%) underwent bronchoscopy and BAL for diagnostic purposes. Only 212 patients (3.3%) met our study criteria. Most patients were excluded because they didn’t have a positive microbiologic or serolgic test at (or around the) time of bronchoscopy. Median age of patients at time of diagnosis was 61 years, with equal male to female ratio. 29.7% of those patients were immunocompromised, mostly due to treatment of active malignancy or connective tissue diseases (58%) or receiving transplant medications (29.7%). Only 11% of patients had preexisting lung disease. 39.2% of patients had bilateral pulmonary involvement. Figure 1 summarizes BAL cellular testing and microbiological results. In 10% of patients, the organism was seen on microscopic examination of the lavage (cytology). Majority of patients had resolution of their infection 83.5%, however 73.4% of them had residual nodules, cavities, or interstitial parenchymal changes. 4.2% of those who recovered required surgical resection (lobectomy or segmentectomy). 16.5% had progression of their disease, 45% of them died due to the extensive pulmonary involvment or its complications. CONCLUSIONS: This study highlights common indications and baseline characteristics of patients undergoing bronchoscopy for BAL in the diagnostic process of PC. Cellular components and testing performances were reported and are highly variable. Symptomatic resolution with residual radiographic findings is the most common clinical outcome. Death occurs in less than 7% of patients and doesn’t correlate with receipt of cancer treatment, immunosuppressive therapy or underlying pulmonary illnesses. CLINICAL IMPLICATIONS: Due to rarity of severe clinical disesae, but worse mortality outcome in immunocomporomised host, bronchoscopy for BAL to establish diagnostic certainitiy of the disease might be necessary due to variable perfomance of serological testing. Cellular components and testing performances are non-specific, but microscopic examination of the BAL alone clinches the diagnosis in 10% of patients. Parenchymal changes after symptomatic resolution do not have clinical implications as the majority of patients in our cohort had residual radiographic changes. DISCLOSURES: No relevant relationships by Abdelmohaymin Abdalla No relevant relationships by Nikita Ashcherkin No relevant relationships by Kenneth Sakata