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Freund O, Hadad Y, Lagziel T, Friedman Regev I, Kleinhendler E, Unterman A, Bar-Shai A, Perluk TM. The Added Value of Bronchoalveolar Lavage for Pulmonary Tuberculosis Diagnosis in High-Risk Hospitalized Patients with Negative Sputum Samples. Adv Respir Med 2023; 92:15-24. [PMID: 38392033 PMCID: PMC10885945 DOI: 10.3390/arm92010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 02/24/2024]
Abstract
Hospitalized patients with a high suspicion of pulmonary tuberculosis (HS-PTB) are isolated until a definite diagnosis can be determined. If doubt remains after negative sputum samples, bronchoscopy with bronchoalveolar lavage (BAL) is often sought. Still, evidence of the added value of BAL in this patient population is scarce. To address this issue, we included consecutive HS-PTB patients with negative sputum samples who underwent BAL between 2017 and 2018. Chest X-rays (CXR) and CT scans were evaluated by a chest radiologist blind to the final diagnosis. Independent predictors for PTB were assessed by multivariate regression, using all positive PTB patients between 2017 and 2019 (by sputum or BAL) as a control group (n = 41). Overall, 42 HS-PTB patients were included (mean age 51 ± 9, 36% female). BAL was a viable diagnostic for PTB in three (7%) cases and for other clinically relevant pathogens in six (14%). Independent predictors for PTB were ≥2 sub-acute symptoms (adjusted OR 3.18, 95% CI 1.04-9.8), CXR upper-lobe consolidation (AOR 8.70, 95% CI 2.5-29), and centrilobular nodules in chest CT (AOR 3.96, 95% CI 1.20-13.0, p = 0.02). In conclusion, bronchoscopy with BAL in hospitalized patients with HS-PTB had a 7% added diagnostic value after negative sputum samples. Our findings highlight specific predictors for PTB diagnosis that could be used in future controlled studies to personalize the diagnostic evaluation.
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Affiliation(s)
- Ophir Freund
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Yitzhac Hadad
- Radiology Department, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel
| | - Tomer Lagziel
- Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Inbal Friedman Regev
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Eyal Kleinhendler
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Avraham Unterman
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
| | - Tal Moshe Perluk
- Institute of Pulmonary Medicine, Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel; (I.F.R.); (A.B.-S.)
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