Abstract
OBJECTIVE To assess the increased diagnostic yield for pulmonary tuberculosis using bronchial washing cultures compared with sputum cultures. METHODS Study conducted with 61 adults in Lima, Peru, from January 2006 to December 2007. The yield of sputum cultures was compared with the yield of acid-fast bacilli smears and cultures of bronchial washing for diagnosing pulmonary tuberculosis in suspected cases of clinical tuberculosis with negative acid fast bacilli sputum smears. RESULTS Twenty seven (95%CI 32;58) of the cases were eventually diagnosed with smear-negative pulmonary tuberculosis. Bronchial washing samples detected 23 (95%CI 72;99) of the smear-negative pulmonary tuberculosis cases compared with 15 (95%CI 37;74) for sputum cultures (p = 0.02). The incremental diagnostic yield of acid fast bacilli smear and culture of bronchial washing specimens over sputum culture was 44% (95%CI 25;65). CONCLUSIONS In function of the epidemiological context and the resources available, bronchoscopy should be deployed as part of a comprehensive work up that optimizes smear-negative pulmonary tuberculosis diagnosis and minimizes risk and costs.
Highlights
According to World Health Organization (WHO), smear negative pulmonary tuberculosis (SNPT) is defined as a case with at least two negative sputum acid fast bacilli (AFB) smears and either a positive culture or radiographic abnormalities consistent with tuberculosis and failure to respond to an antibiotic trial.[5]
There were no complications from the procedure and bronchial washing samples were able to be obtained from all recruited patients
Bronchial washing AFB smears and cultures detected 23/27 cases of SNPT (95%CI 72;99), a significantly higher proportion (p = 0.02) than the 15/27 (95%CI 37;74) cases detected by sputum cultures (Table 1)
Summary
According to World Health Organization (WHO), smear negative pulmonary tuberculosis (SNPT) is defined as a case with at least two negative sputum acid fast bacilli (AFB) smears and either a positive culture or radiographic abnormalities consistent with tuberculosis and failure to respond to an antibiotic trial.[5] Microbiological tests on flexible bronchoscopy samples are considered useful for the diagnosis of SNPT, but their indication is not standardized. Bronchoscopy is not without risk for patients and may be associated with nosocomial transmission of tuberculosis. The reported sensitivity in patients with clinical suspicion of tuberculosis varies from as low as 6.5% to up to 77%.2. Culture in liquid media is seldom performed. It is more sensitive than culture in conventional solid media of sputum and recommended by the WHO,[4] but whether this is the case for bronchoscopy samples is less clear
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