Abstract
Background: Bronchoalveolar lavage (BAL) has been used to recover mycobacterium tuberculosis (MTB) from the respiratory tract of patients with lung infiltrates as nearly 50% of pulmonary tuberculosis (PTB) cases are sputum smear negative for acid fast bacilli (AFB). We prospectively compared the diagnostic yield of induced sputum (IS) smear with BALsmear and culture to assess its role in the early diagnosis of sputum negative PTB.Methods: We performed bronchoscopy to obtain BAL in 52 consecutive patients of suspected PTB between December 2013 and November 2015 after negative results on 2 samples of IS smears. BALsamples were stained with Ziehl-Neelsen (ZN) stain and cultured on L-J media.Results: Cohort of 52 IS negative patients had a mean age of 46 years (SD 15.6) with 58% male participants. Comorbidities were present in 31% participants whereas 42% were current smokers. Tuberculosis was the final diagnosis in 37% (n =19) patients and rest 63% (n = 33) had nontubercular etiologies like bronchiectasis (n = 6), pneumonia (n = 5), interstitial lung disease (n = 3), lung abscess (n = 2), lung cancer (n = 1), PCP (n = 1), hydatid cyst (n = 2), pneumonia (n = 5) and non- specific infection (n = 13). In tuberculosis group 33% patients had bronchoscopic abnormalities. Tuberculosis was confirmed by BALMTB culture in 90% (n = 17) and by biopsy in 10% (n = 2).Conclusion: BAL has high diagnostic yield and should be considered in the evaluation of suspected PTB. Bronchoscopy also picked up alternative diagnoses. JMS 2016; 19(2):75-81.
Highlights
Hypertonic saline induced sputum (IS) has been shown to Worldwide tuberculosis (TB) pulmonary tuberculosis (PTB) is a public health problem of immense proportions with main burden on developing countries which are resource limited
Empiric treatment may result in unnecessary cost and toxicity of anti- tuberculosis therapy (ATT) but we may miss other mimicking diseases malignancy. To address this dilemma we designed the present study to answer whether Bronchoalveolar lavage (BAL) obtained with bronchoscopy provides any additional diagnostic yield after at least two inducedsputum smear tests were reported negative in patients suspected of having active PTB
One 55 year old male smoker who had poorly controlled diabetes with diffuse ground glass opacity (GGO) on high resolution CT (HRCT) scan of chest had pneumocystis jirovici previously known as PCP in BAL fluid
Summary
Hypertonic saline induced sputum (IS) has been shown to Worldwide tuberculosis (TB) pulmonary tuberculosis (PTB) is a public health problem of immense proportions with main burden on developing countries which are resource limited. In the diagnosis of PTB both in terms of higher microscopy and higher culture positivity, results from various studies have confirmed the higher diagnostic yield of bronchoscopy over sputum examination. Empiric treatment may result in unnecessary cost and toxicity of ATT but we may miss other mimicking diseases malignancy To address this dilemma we designed the present study to answer whether BAL obtained with bronchoscopy provides any additional diagnostic yield after at least two inducedsputum smear tests were reported negative in patients suspected of having active PTB. Bronchoalveolar lavage (BAL) has been used to recover mycobacterium tuberculosis (MTB) from the respiratory tract of patients with lung infiltrates as nearly 50% of pulmonary tuberculosis (PTB) cases are sputum smear negative for acid fast bacilli (AFB).
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