Tuberc Respir Dis.  2010 Apr;68(4):218-225.

Differential Cell Analysis and Lymphocyte Subset Analysis in Bronchoalveolar Lavage Fluid from Patients with Miliary Tuberculosis

• Kim JE
• Seol HY
• Cho WH
• Kim KU
• Jeon DS
• Park HK
• Kim YS
• Lee MK
• Park SK

Abstract

BACKGROUND
Bronchoalveolar lavage (BAL) is a useful technique to recover lower airway fluid and cells involved in many respiratory diseases. Miliary tuberculosis is potentially lethal, but the clinical manifestations are nonspecific and typical radiologic findings may not be seen until late in the course of disease. In addition, invasive procedures are often needed to confirm disease diagnosis. This study analyzed the cells and the T-lymphocyte subset in BAL fluid from patients with miliary tuberculosis to determine specific characteristics of BAL fluid that may help in the diagnosis of miliary tuberculosis, using a less invasive procedure.
METHODS
On a retrospective basis, we enrolled 20 miliary tuberculosis patients; 12 patients were male and the mean patient age was 40.5+/-16.2 years. We analyzed differential cell counts of BAL fluid and the T-lymphocyte subset of BAL fluid.
RESULTS
Total cells and lymphocytes were increased in number in the BAL fluid. The percentage of CD4+ T-lymphocytes and the CD4/CD8 ratio in BAL fluid were significantly decreased and the percentage of CD8+ T-lymphocytes was relatively higher. These findings were more prominent in patients infected with the human immunodeficiency virus (HIV). In the HIV-infected patients, the proportion of lymphocytes was significantly higher in BAL fluid than in peripheral blood. There were no significant differences between the BAL fluid and the peripheral blood T-lymphocytes subpopulation.
CONCLUSION
BAL fluid in patients with miliary tuberculosis demonstrated lymphocytosis, a lower percentage of CD4+ T-lymphocytes, a higher percentage of CD8+ T-lymphocytes, and a decreased CD4/CD8 ratio. These findings were more significant in HIV-infected subjects.

Keyword

Tuberculosis, Miliary; Bronchoalveolar Lavage; HIV; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes

MeSH Terms

Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid
CD4-Positive T-Lymphocytes
CD8-Positive T-Lymphocytes
Cell Count
HIV
Humans
Lymphocyte Subsets
Lymphocytes
Lymphocytosis
Male
Retrospective Studies
T-Lymphocyte Subsets
T-Lymphocytes
Tuberculosis, Miliary

Figure

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  Figure 1 Differential cell counts of bronchoalveolar lavage fluid in miliary tuberculosis patients showed increased numbers of total cells and lymphocytes counts.

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  Figure 2 T-lymphocyte population in bronchoalveolar lavage fluid (BALF). (A) Mean percentage of CD4+ T-lymphocytes were significantly decreased and CD8+ T-lymphocytes was higher in miliary tuberculosis. (B) CD4/CD8 ratio in BALF were significantly decreased. These findings were more prominent in human immunodeficiency virus (HIV) infection group.

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  Figure 3 Mean percentage of CD4+T-lymphocytes, CD4/CD8 ratio in peripheral blood and bronchoalveolar lavage fluid (BALF) in human immunodeficiency virus (HIV) infected group were decreased.

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