PURPOSE: Bronchiectasis is the main cause of hemoptysis. When patients with bronchiectasis develop hemoptysis, clinicians often perform bronchoscopy and bronchial washing to obtain samples for microbiological and cytological examinations. Bronchial washing fluids were analyzed from patients with bronchiectasis who developed hemoptysis, and the clinical impacts of these analyses were examined. MATERIALS AND METHODS: A retrospective observational study of patients who underwent fiberoptic bronchoscopy for hemoptysis in Seoul National University Bundang Hospital, a university affiliated tertiary referral hospital, between January 2006 and December 2010 were reviewed. Among them, patients who had bronchiectasis confirmed by computed tomography and had no definite cause of hemoptysis other than bronchiectasis were reviewed. The demographic characteristics, bronchoscopy findings, microbiological data, pathology results and clinical courses of these patients were retrospectively reviewed. RESULTS: A total of 130 patients were reviewed. Bacteria, non-tuberculous mycobacteria (NTM), and Mycobacterium tuberculosis were isolated from bronchial washing fluids of 29.5%, 21.3%, and 0.8% patients, respectively. Suspected causal bacteria were isolated only from bronchial washing fluid in 19 patients, but this analysis led to antibiotics change in only one patient. Of the 27 patients in whom NTM were isolated from bronchial washing fluid, none of these patients took anti-NTM medication during the median follow-up period of 505 days. Malignant cells were not identified in none of the patients. CONCLUSION: Bronchial washing is a useful method to identify microorganisms when patients with bronchiectasis develop hemoptysis. However, these results only minimally affect clinical decisions.
Adult ; Aged ; Aged, 80 and over ; Bronchiectasis/*complications/microbiology ; Bronchoscopy ; Female ; Hemoptysis/*diagnosis/etiology/microbiology ; Humans ; Male ; Middle Aged ; Retrospective Studies

Bronchiectasis is a chronic lung disorder and a number of bacterial pathogens are involved. However, 30%-40% of sputum and purulent samples in good quality failed to grow any pathogenic bacteria, making it difficult to confirm the pathogen. In this study, we collected bronchoalveolar lavage fluid from a bronchiectasis patient undergoing acute exacerbation, and sent for 16S rDNA pyrosequencing by a 454 GS Junior machine. Metagenomic analysis showed the composition of bacterial community in sample was complex. More than a half of reads (51.3%) were from Pseudomonas aeruginosa. This result was corresponding with the culture result but came out 2 d earlier, which is meaningful for early diagnosis and treatment. The detection with 16S rDNA pyrosequencing technology is more sensitive and rapid than routine culture, and can detect the co-infection or symbiosis in airway, giving us a novel and convenient approach to perform rapid diagnosis.
Bronchiectasis ; microbiology ; Bronchoalveolar Lavage Fluid ; chemistry ; microbiology ; Early Diagnosis ; Female ; Humans ; Metagenome ; genetics ; Metagenomics ; methods ; Middle Aged ; Pseudomonas Infections ; microbiology ; Pseudomonas aeruginosa ; genetics ; isolation & purification ; RNA, Ribosomal, 16S ; genetics ; Time Factors

OBJECTIVETo summarize the clinical features of bronchiectasis.

METHODSWe retrospectively analyzed the clinical data of 136 patients who had been admitted to Peking Union Medical College Hospital from January 2010 to December 2012 due to bronchiectasis, which was confirmed by high-resolution computed tomography.

RESULTSThe average age of these 136 patients (61 men and 75 women) was (57.7±16.3) years. The average clinical history was (17.2±15.8) years. The exact etiology was unidentified in 77.2% (105/136) of the patients. The most commonly identified cause was previous infections (14.7%, 20/136), particularly tuberculosis. The main symptoms of bronchiectasis were cough and sputum production. The types of bronchiectasis were cylindrical in 37.7% (37/98), varicose in 40.8% (40/98), cystic in 21.4% (21/98) of these patients. Multilober involvement was most common (77.2%, 105/136). The most commonly involved lobes were left lower lobe (76.5%, 104/136). Of 77 patients who had undergone pulmonary function test, 47 (61.0%) showed obstructive. For each bronchiectasis type, the values (percentages of predicted) of forced expiratory volume in one second (FEV1) (P=0.918), forced vital capacity (FVC) (P=0.982), and FEV1/FVC (P=0.211) showed no statistical significance. The most commonly identified pathogen in sputum culture was Pseudomonas aeruginosa, which was sensitive to most broad-spectrum antibiotics. Current infections were most common in patients with cystic bronchiectasis, among whom rales were frequently heard.

CONCLUSIONSMost bronchiectasis patients are old women. The main etiology is previous infection, especially tuberculosis. The main symptom of bronchiectasis is productive cough. Many patients can have obstructive pulmonary function. The distribution of lesions is diffuse, and the lesions are often seen in both lungs, particularly in the left lower lobe. Cystic bronchiectasis may be a more severe type, and should be carefully managed once identified by radiology.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bronchiectasis ; diagnosis ; microbiology ; Child ; Female ; Humans ; Lung ; physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

No abstract available.
Aged ; Bronchiectasis/*diagnosis/microbiology ; Humans ; Male ; Mycobacterium/classification/*genetics/isolation & purification ; Mycobacterium Infections/*diagnosis/microbiology ; Phylogeny ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/chemistry/genetics/metabolism ; Republic of Korea ; Sequence Analysis, DNA

To determine the relationship between high-resolution computed tomography (HRCT) findings, lung function, and bacteriology in bronchiectasis, we conducted a retrospective study of 49 Korean patients with stable bronchiectasis. To quantify the extent and severity of bronchiectasis, we used a CT scoring system consisting of bronchial dilatation, bronchial wall thickening, the number of bronchiectatic segments, the number of bulla, and the number of emphysema segments. The presence of air-fluid levels and lung consolidation were also evaluated. The results of CT scoring, spirometry and sputum culture were analyzed. Patients with cystic bronchiectasis had higher CT score, more dilated lumen and lower forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), and FEV1/FVC than patients with cylindrical bronchiectasis. Patients with mixed ventilatory impairment had larger number of bronchiectatic segments than patients with obstructive ventilatory impairment. CT score and the number of bronchiectatic segments were significantly associated with FVC and FEV1, while CT score and the number of emphysema segments were significantly associated with FEV1/FVC. Twenty-one patients of 49 patients showed a positive sputum culture including 15 cases of Pseudomonas aeruginosa. The CT score was the most important predictor of lung function. The presence of air-fluid levels predicted bacterial colonization.
Adult ; Body Temperature ; Bronchiectasis/*diagnosis/*microbiology ; Female ; Human ; Korea ; Male ; Middle Aged ; Multivariate Analysis ; Pseudomonas aeruginosa/metabolism ; Respiratory Function Tests ; Retrospective Studies ; Sputum/microbiology ; Tomography, X-Ray Computed/*methods

The nodular bronchiectatic form of nontuberculous mycobacterial (NTM) lung disease and diffuse panbronchiolits (DPB) show similar clinical and radiographic findings. The present study was performed to clarify the clinicoradiographic similarities as well as the differences between NTM lung disease and DPB. The initial clinicoradiographic features of 78 patients with the nodular bronchiectatic form of NTM lung disease (41 patients with Mycobacterium avium complex infection and 37 patients with Mycobacterium abscessus infection) were compared with those of 35 patients with DPB. Old age, female sex, a history of tuberculosis treatment, and hemoptysis were related to NTM lung disease while exertional dyspnea, coarse crackles, history of sinusitis, obstructive abnormalities in pulmonary function tests, and hypoxemia were related to DPB. The number of lobes involved with bronchiolitis and bronchiectasis on chest computed tomography were more numerous in DPB patients. There is considerable overlap in the clinical and radiographic appearances of the nodular bronchiectatic form of NTM lung disease and DPB, although some clinicoradiographic features differ between two diseases. The correct diagnosis, including aggressive microbiologic evaluation, should be made for the appropriate management of patients presenting with bilateral bronchiectasis and bronchiolitis.
Adult ; Age Factors ; Aged ; Bronchiectasis/*diagnosis/radiography ; Bronchiolitis/*diagnosis/radiography ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases/*diagnosis/microbiology/radiography ; Male ; Middle Aged ; Mycobacterium Infections/*diagnosis/radiography ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/diagnosis/radiography ; Respiratory Function Tests ; Sex Factors ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/therapy

The nodular bronchiectatic form of nontuberculous mycobacterial (NTM) lung disease and diffuse panbronchiolits (DPB) show similar clinical and radiographic findings. The present study was performed to clarify the clinicoradiographic similarities as well as the differences between NTM lung disease and DPB. The initial clinicoradiographic features of 78 patients with the nodular bronchiectatic form of NTM lung disease (41 patients with Mycobacterium avium complex infection and 37 patients with Mycobacterium abscessus infection) were compared with those of 35 patients with DPB. Old age, female sex, a history of tuberculosis treatment, and hemoptysis were related to NTM lung disease while exertional dyspnea, coarse crackles, history of sinusitis, obstructive abnormalities in pulmonary function tests, and hypoxemia were related to DPB. The number of lobes involved with bronchiolitis and bronchiectasis on chest computed tomography were more numerous in DPB patients. There is considerable overlap in the clinical and radiographic appearances of the nodular bronchiectatic form of NTM lung disease and DPB, although some clinicoradiographic features differ between two diseases. The correct diagnosis, including aggressive microbiologic evaluation, should be made for the appropriate management of patients presenting with bilateral bronchiectasis and bronchiolitis.
Adult ; Age Factors ; Aged ; Bronchiectasis/*diagnosis/radiography ; Bronchiolitis/*diagnosis/radiography ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases/*diagnosis/microbiology/radiography ; Male ; Middle Aged ; Mycobacterium Infections/*diagnosis/radiography ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/diagnosis/radiography ; Respiratory Function Tests ; Sex Factors ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/therapy