Clinical Utility of Stepwise Bronchoalveolar Lavage Fluid Analysis in Diagnosing and Managing Lung Infiltrates in Leukemia/Lymphoma Patients With Febrile Neutropenia.

PURPOSE: Febrile neutropenia (FN) is a serious complication in hematologic malignancies, and lung infiltrates (LIs) remain a significant concern. An accurate microbiological diagnosis is crucial but difficult to establish. To address this, we analyzed the utility of a standardized method for performing bronchoalveolar lavage (BAL) along with a two-step strategy for the analysis of BAL fluid. PATIENTS AND METHODS: This prospective observational study was conducted at a tertiary cancer center from November 2018 to June 2020. Patients age 15 years and older with confirmed leukemia or lymphomas undergoing chemotherapy, with presence of FN, and LIs observed on imaging were enrolled. RESULTS: Among the 122 enrolled patients, successful BAL was performed in 83.6% of cases. The study used a two-step analysis of BAL fluid, resulting in a diagnostic yield of 74.5%. Furthermore, antimicrobial therapy was modified in 63.9% of patients on the basis of BAL reports, and this population demonstrated a higher response rate (63% v 45%; P = .063). CONCLUSION: Our study demonstrates that a two-step BAL fluid analysis is safe and clinically beneficial to establish an accurate microbiological diagnosis. Given the crucial impact of diagnostic delays on mortality in hematologic malignancy patients with FN, early BAL studies should be performed to enable prompt and specific diagnosis, allowing for appropriate treatment modifications.

Primary tonsillar tuberculosis masquerading as carcinoma of the tonsil.

Primary tuberculosis (TB) of tonsil is a rare form of extra-pulmonary tuberculosis. Most tonsillar TB cases present with coexistent pulmonary tuberculosis. It can simulate tonsillar malignancy and poses a diagnostic challenge. Histopathological examination is often needed for confirmation. Herein, we report a case of primary tonsillar tuberculosis in a 55-year-old gentleman mimicking carcinoma of the tonsil.

Correction to: The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection.

The original article has been corrected.

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection.

Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra- and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.

Piggyback mycosis: pulmonary hydatid cyst with a mycotic co-infection.

The lungs are common sites for the occurrence of saprophytic or invasive mycosis as well as hydatid cysts. The two diseases seldom coexist, and the manifestation is seen as a fungal ball (usually aspergilloma) formed in the cavity left behind after hydatid cystectomy. Active invasion and proliferation of the fungi in the laminated ectocyst or sometimes the pericyst of the hydatid is very unusual. We report such a unique coexistence identified in two of the six surgically excised pulmonary hydatid cysts in the past 2 years. Both were immunocompetent males, who had presented with non-specific symptoms of cough, haemoptysis and chest pain. The septate slender hyphae of the invading fungus resembled those of Aspergillus.

Bronchoscopy in pulmonary hydatidosis: retrospective analysis.

The diagnosis of unruptured pulmonary hydatidosis is based on classical radiologic features. However, ruptured or complicated hydatid cysts alter the radiologic signs and lead to delayed or incorrect diagnosis. The role of flexible bronchoscopy was assessed as a diagnostic tool in the evaluation in such cases. Between 2002 and 2008, 14 patients (7 female, 7 male), aged between 18 and 55 years, with a mean age of 36 years, were evaluated for pulmonary hydatidosis. Clinical history, radiologic findings, and other investigations of the patients were reviewed retrospectively at a tertiary referral center. All 14 patients were symptomatic, with cough, hemoptysis, and chest pain being the most common symptoms. Seven patients had right lung involvement, whereas 6 patients had left-sided predilection, and the remainder presented with pleural disease. At flexible bronchoscopy, white glistening membrane could be observed in 9 patients, whereas cytologic evaluation of bronchial washing did not show cuticular particles, degenerated scoleces, or hooklets in any of the cases. Twelve patients underwent uneventful surgical intervention. Surgical specimens showed 2 unruptured pulmonary hydatid cysts (uncomplicated), 1 pleural hydatid, and 9 ruptured pulmonary hydatid cysts. Of the 9 ruptured hydatid cyst cases, evidence of fungal (aspergillus) colonization, bacterial infection, and coexistent tuberculous granuloma was reported in 2 cases each. Bronchoscopy is an important tool that aids in confirming the diagnosis before surgery, especially in complicated pulmonary hydatidosis. Special stains for cytologic specimen should be used if the possibility of ruptured hydatid is thought to improve the diagnostic yield. The histopathology of the surgical specimen should be reviewed for associated secondary infection and fungal colonization.