This is a real quick one.
50 yo female with hilar/mediastinal adenopathy and a mild restrictive vent defect. Clinical picture points to sarcoid. She has mild dyspnea on exertion.
Bronch with TBBx, Wang needle performed. Her airways are edematous and inflammed, but not profoundly so.
TBBx shows non-caseating granulomas and the Wang has granulomas as well (the 19 gauge needle is really wonderful).
Anyway, the BAL culture shows Strep Pneumo (PCN sensitive).
She has NO infectious respiratory symptoms/
Would you treat?
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What was the BAL colony forming units?
The standard is anything over 10^3 CFU/mL has a 90% sensitivity for
and 97% specificity for "pneumonia" (this was in vented patients I think so extrapolate at your own risk). I know there are problems with this data also because of lack of a gold standard, but you got to take what you can get. A CFU might help you here especially if it was really high. And especially if you were about to give long-term steroids.
It is hard to get too worried. Pneumococcus doesn't cause chronic lung disease and can be found in upper airways (does the patient have sinus disease?) and some may have been dragged down by the scope. I suspect that without the Cx there would be no indication for ABTx in this case so I would probably ignore the Cx and observe for symptoms. Conversely, if the Pt now has resp symptoms, you have a Cx to guide therapy...
I don't know about Beaumont but our hospital lab won't do quantitaive Cxs on our BALs :(
Our lab will not do quantitative cultures either. I also felt that this was simply in her sinuses that colonized the scope while I was doing the procedure.
Just wanted to see if anyone else would hold off treating like I have
I would hold off too.
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