Usefulness of bronchoalveolar lavage in the management of patients presenting with lung infiltrates and suspect COVID-19-associated pneumonia: A case report. (August 2020)

• Record Type: Journal Article
• Authors: Gualano, Gina; Musso, Maria; Mosti, Silvia; Mencarini, Paola; Mastrobattista, Annelisa; Pareo, Carlo; Zaccarelli, Mauro; Migliorisi, Paolo; Vittozzi, Pietro; Zumla, Alimudin; Ippolito, Giuseppe; Palmieri, Fabrizio
• Is Part Of: International journal of infectious diseases. Volume 97(2020)
• Page Start: 174
• Page End: 176
• Publication Date: 2020-08
• Subjects: COVID-19 -- Nasopharyngeal swabs -- SARS CoV2 pneumonia -- BAL fluid; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.05.027
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Collection of throat swabs is not a standardized procedure, and caution should be taken if negative result is taken as the criterion for the exclusion of SARS-CoV-2 infection Nasopharyngeal swabs may result negative for SARS-CoV-2 in patients with lung infiltrates RT-PCR for SARS-CoV-2 in lower respiratory samples may help diagnosis Healthcare workers should perform aerosol-generating procedures in an adequately ventilated room and should wear adequate PPE. 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.