Usefulness of bronchoalveolar lavage in the management of patients presenting with lung infiltrates and suspect COVID-19-associated pneumonia: A case report

Gina Gualano; Maria Musso; Silvia Mosti; Paola Mencarini; Annelisa Mastrobattista; Carlo Pareo; Mauro Zaccarelli; Paolo Migliorisi; Pietro Vittozzi; Alimudin Zumla; Giuseppe Ippolito; Fabrizio Palmieri

doi:10.1016/j.ijid.2020.05.027

Usefulness of bronchoalveolar lavage in the management of patients presenting with lung infiltrates and suspect COVID-19-associated pneumonia: A case report

Int J Infect Dis. 2020 Aug:97:174-176. doi: 10.1016/j.ijid.2020.05.027. Epub 2020 May 11.

Authors

Affiliations

¹ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: gina.gualano@inmi.it.
² National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: maria.musso@inmi.it.
³ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: silvia.mosti@inmi.it.
⁴ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: paola.mencarini@inmi.it.
⁵ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: a.mastrobattista@inmi.it.
⁶ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: carlo.pareo@inmi.it.
⁷ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: mauro.zaccarelli@inmi.it.
⁸ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: paolo.migliorisi@inmi.it.
⁹ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: pietro.vittozzi@inmi.it.
¹⁰ Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom. Electronic address: a.i.zumla@ucl.ac.uk.
¹¹ National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: giuseppe.ippolito@inmi.it.
¹² National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: fabrizio.palmieri@inmi.it.

Abstract

Objective: To report a clinical case of a patient with a compatible HRCT scan and two negative SARS-CoV-2 RNA upper respiratory tract specimens but with a confirmed viral infection by BAL (19 days after symptom onset).

Methods: Revision of a patient's clinical charts with COVID-19 admitted at INMI L. Spallanzani Hospital RESULTS: Two oropharyngeal swab tests of SARS-CoV-2 by qualitative real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay were performed at admission (17 days from symptoms onset) and a day apart and were found negative. BAL fluid collected 19 days after symptoms onset was positive for SARS-CoV-2.

Conclusion: This case highlights importance of clinical suspicion of SARS-CoV-2 infection in diagnosis and infectivity assessment. We suggest collection of BAL fluid when consecutive nasopharyngeal swabs are negative, to confirm or exclude the diagnosis of COVID-19-associated pneumonia. Healthcare workers should perform aerosol-generating procedures in an adequately ventilated room and should wear adequate PPE.

Keywords: BAL fluid; COVID-19; Nasopharyngeal swabs; SARS CoV2 pneumonia.

Publication types

Case Reports

MeSH terms

Aged
Betacoronavirus* / genetics
Bronchoalveolar Lavage*
COVID-19
COVID-19 Testing
COVID-19 Vaccines
Clinical Laboratory Techniques
Coronavirus Infections / diagnosis
Coronavirus Infections / therapy*
Female
Hospitalization
Humans
Pandemics
Pneumonia, Viral / diagnosis
Pneumonia, Viral / therapy*
Real-Time Polymerase Chain Reaction
Respiratory System
SARS-CoV-2