A prospective study to evaluate the utility of bronchoalveolar lavage by fiberoptic bronchoscopy in sputum smear negative patients with high suspicion of pulmonary tuberculosis

Abstract

Aim: To evaluate the utility of bronchoalveolar lavage (BAL) by flexible fiberoptic bronchoscopy (FOB) in sputum smear negative patients with clinical and radiological characteristics of pulmonary tuberculosis (PTB). Materials and Methods: This prospective study was carried out in 30 sputum smear negative patients of age group 20 to 70 years, who were highly suspicious for PTB by clinical and radiographic criteria. All patients were subjected to sputum culture, BAL stains and cultures, and cytopathology. Patients with moderate to massive pleural effusion, obvious accessible lymph node, history of antitubercular therapy (ATT), and contraindication to FOB were excluded. Results: Sputum culture for acid fast bacilli (AFB) was positive in four (12%) patients, BAL fluid was positive for Ziehl-Neelsen (ZN) stain in nine (27%) patients, including four sputum culture patients, while BAL culture for AFB on Lowenstein-Jensen (LJ) medium was positive in 18 (60%), including 9 BAL fluid ZN stain positive patients. Six (20%) patients had growth on pyogenic culture, while two (7%) patients had malignant cell on cytological examination of BAL fluid. Remaining four (13%) patients were empirically started on ATT. They had complete response to ATT at 2 months and were retrospectively diagnosed with pulmonary tuberculosis (PTB). All the bacteriologically confirmed PTB patients were given ATT for 6 months and all patients had complete response. Conclusion: We concluded that FOB guided BAL is extremely useful for establishing diagnosis of PTB or other pulmonary diseases in sputum smear negative patients, who have high suspicion for PTB by clinical and radiographic criteria.