Diagnosing diffuse lung disease in children in a middle-income country: The role of open lung biopsy

SETTING: A tertiary care hospital situated in a middleincome country with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE : To determine the diagnostic yield of open lung biopsy (OLB) in children with diffuse lung disease (DLD), comparing findings in HIV-infected and non- HIV-infected children. DESIGN: This 9-year retrospective study included 51 children with DLD (oxygen-dependent or on artificial ventilation), who required an OLB where the diagnosis remained uncertain after extensive investigations. RESULT S : The median age was 7 months, median body weight was 6.6 kg (61% were severely malnourished) and 30% were HIV-infected (62% on antiretroviral treatment). The diagnostic yield of the OLB was 86% (n 44) and was significantly higher in HIV-infected (77%) than in non-HIV-infected (48%) children (P 0.01). Pneumonia was the most common diagnosis (n 25, 57%), with common agents being cytomegalovirus (CMV), viruses other than CMV, Pneumocystis jiroveci pneumonia and previously undiagnosed TB (10%). Mycobacterium tuberculosis as a cause of DLD was not suspected before the OLB, as all investigations for TB were negative. Non-infectious causes of DLD were established in 10% of cases. CONCLUS ION: The OLB is a useful diagnostic tool to diagnose idiopathic DLD, including TB, in young children. © 2017 The Union.