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Fiberoptic bronchoscopy in the diagnosis of pulmonary fungal and nocardial infarctions.

In order to evaluate the role of fiberoptic bronchoscopic procedures in the diagnosis of pulmonary fungal and nocardial infections, we evaluated all patients seen during a 30-month period in whom Histoplasma capsulatum, Blastomyces dermatitidis, Cryptococcus neoformons, Aspergillus fumigatus , or Nocardia asteroides were found in material obtained from the lungs. Thirty-six such patients were seen; and of these, 25 were found to have pulmonary disease related to the organism found. Ten of 11 isolations of C neoformons were from patients with no apparent related disease. Thirteen patients underwent fiberoptic bronchoscopic examination because smears of sputum were negative or were unavailable for examination or because of active hemoptysis. In three patients the diagnosis was first made from bronchial brushings performed during a fiberoptic bronchoscopic procedure. In one patient with nocardiosis, samples of sputum were not available, and in two patients (one with blastomycosis and one with histoplasmosis), samples of sputum were not diagnostic. While examination of sputum remains the principal method of diagnosing these infections, a fiberoptic bronchoscopic procedure with proper examination of bronchial brushings may be indicated if samples of sputum are not available or if the patient is extremely ill. In such cases, it may decrease the total time of hospitalization and eliminate the need for more extensive diagnostic procedures.