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Bronchoalveolar lavage-based COVID-19 testing in patients with cancer. Hematol Oncol Stem Cell Ther 2021 Mar;14(1):65-70

Date

10/16/2020

Pubmed ID

33058787

Pubmed Central ID

PMC7543702

DOI

10.1016/j.hemonc.2020.09.002

Scopus ID

2-s2.0-85092735525   10 Citations

Abstract

OBJECTIVE/BACKGROUND: 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: 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: 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: 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.

Author List

Abid MB, Chhabra S, Buchan B, Graham MB, Abedin S, Thapa B, D'Souza A, George B, Hamadani M

Authors

Sameem Abedin MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Muhammad Bilal Abid MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Blake W. Buchan PhD Associate Professor in the Pathology department at Medical College of Wisconsin
Anita D'Souza MD Associate Professor in the Medicine department at Medical College of Wisconsin
Ben George MD Associate Professor in the Medicine department at Medical College of Wisconsin
Mary Beth Graham MD Associate Chief, Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Bronchoalveolar Lavage
Humans
Male
Neoplasms
Retrospective Studies