Detection of tuberculosis in smear predator pulmonary TB in Fayoum Chest Hospital

Abstract

BackgroundTuberculosis (TB) is one of the causes of health problem in millions of people annually, and in 2015, it was one of the top 10 reasons of doom worldwide, ranking above HIV/AIDS as one of the important causes of death owing to an intended disease.A negative smear result in pulmonary TB is believed to be a widespread clinical problem, so early detection of smear-negative pulmonary tuberculosis (SNPTB) is important for TB control and restriction of number of deaths, and it is tricky in these patients.AimsTo detect TB in SNPTB in Fayoum Chest HospitalDesignThis was a retrospective study.SettingFayoum Chest Hospital and Fayoum University Hospital in Egypt were used for conducting the study between 2015 and 2017.Patients and methodsFifty patients suspected to have pulmonary TB and had negative sputum smear results were included in the study.For each patient, full history was taken, and clinical body checkup was done. Then, plain posteroanterior chest radiograph was done. Tuberculin test, direct sputum examination, and other diagnostic methods used for detection such as GeneXpert, bronchoscopy, bronchoalveolar lavage (BAL), transbronchial lung biopsy, Löwenstein–Jensen culture, QuantiFERON, or even open lung biopsy were recorded.Statistical analysisCoding of the data was done then entered with SPSS (Statistical Package for the Social Sciences) version number 18 windows 7 after that data were summarized using mean, standard deviation, median, minimum and maximum in the quantitative data with using frequency (count) & relative frequency (percentage) for categorization of data.ResultsIt was found that 42% of patients were diagnosed by GeneXpert and 46% were diagnosed by BAL during bronchoscopy, whereas 68% of patients had positive ‘Löwenstein–Jensen culture’ result.ConclusionThe GeneXpert MTB/RIF assay is an important test for quick diagnosis of acid-fast bacilli SNPTB.Flexible fiberoptic bronchoscopy is a beneficial tool in the diagnosis of pulmonary TB in patients whose sputum smear is negative.Clinical implications are as follows: in patients with SNPTB, microbiological samples should be obtained (through sputum, BAL, or induced sputum), and then radiological investigation should be performed. Thereafter, antituberculous treatment should be started following the diagnosis, with follow-up of the case.Rapid detection and proper treatment of pulmonary TB, even in smear negative patients, can eliminate spread of the infection to others and may decrease the severity of the disease.