Background: Post-bronchoscopy and bronchoalveolar lavage (BAL) fever in children has been described by several authors. Objectives: This study aimed at assessing the occurrence of fever after these examinations and associated risk factors. Methods: The study was performed in the Bronchoscopy Unit of Hôpital Necker-Enfants Malades, Paris, France, from June 2004 to July 2005. 148 children who underwent fiberoptic bronchoscopy and BAL, and remained in the Unit for 24 h, were included. Results: 37.8% of the patients presented post-BAL fever. In the multivariate analysis of the selected factors (age, immunodeficiency, general or local anesthesia, mucosal biopsy, inflammation and suppuration at the moment of the examination, abnormal bronchoalveolar fluid cellularity and infection), only age <2 years and presence of infection remained associated with fever. Conclusions: The occurrence of fever is a frequent event in children who underwent BAL. In order to reduce post-BAL fever, antibiotic strategies should be devised based on prospective studies assessing identification of predictive air-way infection criteria and/or rapid bacteriological result analysis.

1.
Picard E, Schlesinger Y, Goldberg S, et al: Fatal pneumococcal sepsis following flexible bronchoscopy in a immunocompromised infant. Pediatr Pulmonol 1998;25:390–392.
2.
Riedler J, Grigg J, Stone C, Tauro G, Robertson C: Bronchoalveolar lavage cellularity in healthy children. Am J Respir Crit Care Med 1995;152:163–168.
3.
Ratjen F, Bredendiek M, Brendel M, Meltzer, Costabel U: Differential cytology of bronchoalveolar lavage fluid in normal children. Eur Respir J 1994;7:1865–1870.
4.
Payne D, McKenzie SA, Stacey S, Misra D, Haxby E, Bush A: Safety and ethics of bronchoscopy and endobronchial biopsy in difficult asthma. Arch Dis Child 2001;84:423–426.
5.
Schelhase D, Tamez JR, Menendez AA, Morris MG, Fowler GW, Lensing SY: High fever after flexible bronchoscopy and bronchoalveolar lavage in non-critically ill immunocompetent children. Pediatr Pulmonol 1999;28:139–144.
6.
ERS Task Force on Bronchoalveolar Lavage in Children: Bronchoalveolar lavage in children. Eur Respir J 2000;15:217–231.
7.
Picard E, Schwartz S, Goldberg S, Gçlick T, Villa Y, Kerem E: A prospective study of fever and bacteremia after flexible fiberoptic bronchoscopy in children. Chest 2000;117:573–577.
8.
Um SW, Choi CM, Lee CT, Kim YW, Han SK, Shim YS, Yoo CG: Prospective analysis of clinical characteristics and risk factors of post-bronchoscopy fever. Chest 2004;125:945–952.
9.
Krause A, Hohberg B, Heine F, John M, Burmester GR, Witt C: Cytokines derived from alveolar macrophages induce fever after bronchoscopy and bronchoalveolar lavage. Am J Respir Crit Care Med 1997;155:1793–1797.
10.
Timms RM, Harrell JH: Bacteremia related to fiberoptic bronchoscopy. Am Rev Respir Dis 1977;111:555–557.
11.
Alexander WJ, Baker GL, Hunker FD: Bacteremia and meningitis following fiberoptic bronchoscopy. Arch Intern Med 1979;139:580–582.
12.
Pereira WJ, Kovnat DN, Khan MA, Iacovino JR, Spivack ML, Snider GL: Fever and pneumonia after flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1975;112:59–64.
13.
Vega-Briceño LE, Holmgren NL, Bertrand P, Rodriguez JI, Barriga F, Contreras I, Sánchez I: Utility of bronchoalveolar lavage in immunocompromised children: diagnostic yield and complications. Arch Bronconeumol 2004;40:570–574.
14.
De Blic J, Marchac V, Scheinmann P: Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J 2002;20:1271–1276.
15.
Bibi H, Shoseyov D, Armoni M, Ohali M, Pollak S, Schlesinger M: Pediatric flexible bronchoscopy. Harefuah 1997;132:399–401.
16.
Gillis S, Dann EJ, Berkman N, Koganox Y, Kramer MR: Fatal Hemophilus influenzae septicemia following bronchoscopy in a sple- nectomized patient. Chest 1993;104:1607–1609.
17.
Timms RM, Harrell JH: Bacteremia related to fiberoptic bronchoscopy. Am Rev Respir Dis 1977;111:555–557.
18.
Yigla M, Oren I, Bentur L, Solomonov A, Elias N, Altshuler R, Rubin AE, Lejbkowicz F: Incidence of bacteraemia following fiberoptic bronchoscopy. Eur Respir J 1999;14:789–791.
19.
Dinarello CA: Interleukin-1 and interleukin-1 antagonism. Blood 1991;77:1627–1652.
20.
Brach MA, Herrmann F: Interleukin-6: presence and future. Int J Clin Lab Res 1992;22:143–151.
21.
Tracey KJ, Cerami A: Tumor necrosis factor: an updated review of its biology. Crit Care Med 1993;21:S415–S422.
22.
Terashima T, Amakawa K, Matsumaru A, Van Eeden S, Hogg JC, Yamaguchi K: BAL induces an increase in peripheral blood neutrophils and cytokine levels in healthy volunteers and patients with pneumonia. Chest 2001;119:1724–1729.
23.
Nelson ME, Wald TC, Bailey K, Wesselius LJ: Intrapulmonary cytokine accumulation following BAL and the role of endotoxin contamination. Chest 1999;115:151–157.
24.
Nayci A, Atis S, Ersoz G, Polat A: Gut decontamination prevents bronchoscopy-induced bacterial translocation. Respiration 2004;71:66–71.
25.
Ozkurt S, Herek O, Atalay H, Kaleli I, Kara CO: Does rigid bronchoscopy induce bacterial translocation? An experimental study in rats. Respiration 2005;72:85–88.
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