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Rakha MA, Ali A, Hassan W, Al-Anbay E. GeneXpert analysis of bronchoalveolar lavage (BAL) samples: promising diagnostic modality in patients with smear-negative pulmonary tuberculosis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose
The aim of the study is to assess the diagnostic utility of bronchoalveolar lavage (BAL) samples with GeneXpert test in diagnosis of TB in smear-negative patients.
Method
One-hundred sixty-nine cases were included in this study, as they had a radiological finding suggested to have pulmonary tuberculosis, while the sputum direct smear examination for acid-fast bacilli was negative. All cases prepared to do fiber-optic bronchoscope with bronchoalveolar lavage collection after their consent and post bronchoscope sputum collection for further molecular and microbiological examination.
Results
The combined diagnostic yield of all bronchoscopy procedures was 15.97% (27 cases of 169) and the final diagnosis of TB cases was established in 16 cases of 169 (9.4%) using BAL culture and in 20 cases of 169 (11.83%) by GeneXpert methods. Post bronchoscope direct sputum examination, culture, and GeneXpert evaluation gave diagnostic yield about 1.1%, 5.5%, and 7.1%, respectively. The specificity of GeneXpert examination of BAL and post bronchoscope sputum was 95.42% and 97.38%, respectively.
Conclusion
Early detection of pulmonary tuberculosis using fiber-optic bronchoscope BAL examination and post bronchoscope sputum with GeneXpert method promotes the accurate decision to start antituberculous therapy in patients with smear negative.
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Zhou Y, Peng J, Zhu W, Ke Y, Shan L. Clinical study of multifunctional laryngeal mask in airway interventional therapy. Medicine (Baltimore) 2022; 101:e31388. [PMID: 36397451 PMCID: PMC9666165 DOI: 10.1097/md.0000000000031388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study is conducted to evaluate the efficacy and safety of using multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy. METHODS A total of 200 patients receiving airway interventional therapy were enrolled in this retrospective study and were divided into 2 groups (group M and group P) by doctors in our hospital to compare the effect of different laryngeal masks. Group M used common laryngeal masks and an anesthesia machine for positive pressure ventilation while group P took multifunctional intubation laryngeal masks and used a jet ventilator for normal frequency jet ventilation. The patients' mean arterial pressure, heart rate, arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2), and the operation time, recovery score and the patients' and doctors' satisfaction levels were compared between the 2 groups. RESULTS Both groups were hemodynamically stable, and their PaO2 levels were significantly higher before the operation than that during and after the operation (P < .05). Compared with group M, the PaCO2 level of group P was more stable both during and after the operation, and this difference was statistically significant (P < .05). There was no statistically significant difference in terms of the 2 group's operating time, recovery score, and patients' satisfaction levels (P > .05). However, the satisfaction levels of doctors in group P were higher than that in group M, and this difference was statistically significant (P < .05). CONCLUSION As statistics show, the intraoperative hemodynamics and PaO2 and PaCO2 levels were stable, and patients, surgeons and anesthesia operators were satisfied. Therefore, it is feasible to apply multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy and it is a safe and ideal way to ensure ventilation.
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Affiliation(s)
- Yuan Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Jianliang Peng
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Wujian Zhu
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Yazhen Ke
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Ligang Shan
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
- *Correspondence: Ligang Shan, Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian Province 361021, P.R. China (e-mail: )
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Brito GMXD, Mafort TT, Ribeiro-Alves M, Reis LVTD, Leung J, Leão RS, Rufino R, Rodrigues LS. Diagnostic performance of the Xpert MTB/RIF assay in BAL fluid samples from patients under clinical suspicion of pulmonary tuberculosis: a tertiary care experience in a high-tuberculosis-burden area. ACTA ACUST UNITED AC 2021; 47:e20200581. [PMID: 34008762 PMCID: PMC8332835 DOI: 10.36416/1806-3756/e20200581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of the Xpert MTB/RIF assay, a rapid molecular test for tuberculosis, comparing it with that of AFB staining and culture, in BAL fluid (BALF) samples from patients with clinically suspected pulmonary tuberculosis (PTB) who are sputum smear-negative or produce sputum samples of insufficient quantity. METHODS This was a retrospective study of 140 cases of suspected PTB in patients who were smear-negative or produced insufficient sputum samples and were evaluated at a tertiary teaching hospital in the city of Rio de Janeiro, Brazil. All of the patients underwent fiberoptic bronchoscopy with BAL. The BALF specimens were evaluated by AFB staining, mycobacterial culture, and the Xpert MTB/RIF assay. RESULTS Among the 140 patients, results for all three microbiological examinations were available for 73 (52.1%), of whom 22 tested positive on culture, 17 tested positive on AFB staining, and 20 tested positive on the Xpert MTB/RIF assay. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for AFB staining were 68.1%, 96.1%, 88.2%, 87.5%, and 87.6%, respectively, compared with 81.8%, 96.1%, 90.0%, 92.4%, and 91.8%, respectively, for the Xpert MTB/RIF assay. The agreement between AFB staining and culture was 82.3% (kappa = 0.46; p < 0.0001), whereas that between the Xpert MTB/RIF assay and culture was 91.8% (kappa = 0.8; p < 0.0001). CONCLUSIONS In BALF samples, the Xpert MTB/RIF assay performs better than do traditional methods, providing a reliable alternative to sputum analysis in suspected cases of PTB. However, the rate of discordant results merits careful consideration.
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Affiliation(s)
- Guilherme Machado Xavier de Brito
- . Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Thiago Thomaz Mafort
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Marcelo Ribeiro-Alves
- . Laboratório de Pesquisas Clínicas em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Larissa Vieira Tavares Dos Reis
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Janaína Leung
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Robson Souza Leão
- . Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Rogério Rufino
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Luciana Silva Rodrigues
- . Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
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Narula N, Iannuzzi M. Sarcoidosis: Pitfalls and Challenging Mimickers. Front Med (Lausanne) 2021; 7:594275. [PMID: 33505980 PMCID: PMC7829200 DOI: 10.3389/fmed.2020.594275] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.
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Affiliation(s)
- Naureen Narula
- Staten Island University Hospital, New York, NY, United States
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Patterson B, Wood R. Is cough really necessary for TB transmission? Tuberculosis (Edinb) 2019; 117:31-35. [PMID: 31378265 PMCID: PMC6688829 DOI: 10.1016/j.tube.2019.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/06/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Cough has long been implicated in the production of infectious aerosol leading to transmission of tuberculosis (TB). However, prevalence studies frequently identify radiographic evidence of TB in subclinical individuals in the absence of reported coughing. Elucidating the role of cough in transmission depends on understanding the physical process of aerosolizing and expelling mycobacterium tuberculosis (Mtb) bacilli. In the last decade, human aerosol studies have progressed with improved precision of particle detection and greater sophistication of experimental protocols. Combining principles of respiratory physiology, the site and mechanism of aerosolization of respiratory lining fluids during phases of the respiratory cycle has been investigated in detail. Additionally, recent success in the direct detection of naturally generated Mtb aerosols has allowed more detailed characterization in terms of their rate of production and size distribution. We propose that TB transmission depends on the coincidence of the site of aerosol generation with the presence of Mtb bacilli. This review will examine the evidence for site of aerosol production during cough and respiratory activities in conjunction with the characteristics of detectable Mtb aerosols and locations of tuberculosis infection. Furthermore, we propose respiratory activities that are likely to optimise aerosol sampling for investigation of transmission.
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Affiliation(s)
- Benjamin Patterson
- University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands; Desmond Tutu HIV Centre, IDM, University of Cape Town, Cape Town, South Africa.
| | - Robin Wood
- Desmond Tutu HIV Centre, IDM, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ahmad M, Ibrahim WH, Sarafandi SA, Shahzada KS, Ahmed S, Haq IU, Raza T, Hameed MA, Thomas M, Swehli HAI, Sattar HA. Diagnostic value of bronchoalveolar lavage in the subset of patients with negative sputum/smear and mycobacterial culture and a suspicion of pulmonary tuberculosis. Int J Infect Dis 2019; 82:96-101. [PMID: 30904678 DOI: 10.1016/j.ijid.2019.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The diagnostic value of bronchoalveolar lavage in patients with negative sputum/smear for tuberculous bacilli has been well studied. However, its value in the subset of patients with both negative sputum/smear and culture is seldom reported. METHODS A retrospective study of patients referred for diagnostic bronchoscopy for the suspicion of pulmonary tuberculosis during the period from April 1st, 2015 to March 30th, 2016, and who had negative sputum/smear and culture for tuberculous bacilli. RESULTS One hundred and ninety patients fulfilled the inclusion criteria. Bronchoalveolar lavage detected further 61/190 (32.1%) pulmonary tuberculosis cases. Bronchoalveolar lavage mycobacterial culture and polymerase chain reaction (positive in 60/190 (31.6%) and 58/190 (30.5%) of patients respectively) provided the highest diagnostic yield, whereas direct smear provided the lowest yield. Bronchoalveolar lavage had a sensitivity of 89.7%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 94.6%, and a test accuracy of 96.3% in suspected pulmonary tuberculosis cases with negative sputum/smear and culture. Positive bronchoalveolar lavage yield for tuberculosis was significantly associated with a positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, radiological evidence of upper zone abnormality and patient's origin being from the Indian subcontinent. CONCLUSION Bronchoalveolar lavage should be pursued as a useful diagnostic tool for suspected pulmonary tuberculosis cases when sputum/smear and culture are negative. Its value is higher in the subset of patients with positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, upper zone abnormality on radiograph or being from the Indian subcontinent.
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Affiliation(s)
- Mushtaq Ahmad
- Department of Medicine, Hamad General Hospital, Weill-Cornell Medical College, Doha, Qatar.
| | - Wanis H Ibrahim
- Hamad General Hospital, Qatar University and Weill-Cornell Medical College, Doha, Qatar.
| | | | | | - Shakeel Ahmed
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
| | - Irfan Ul Haq
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
| | - Tasleem Raza
- Hamad General Hospital, Weill-Cornell Medical College, Doha, Qatar.
| | | | - Merlin Thomas
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
| | | | - Hisham A Sattar
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
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Hermes R, Saragusty J, Moser I, Holtze S, Nieter J, Sachse K, Voracek T, Bernhard A, Bouts T, Göritz F, Hildebrandt TB. Bronchoalveolar lavage for diagnosis of tuberculosis infection in elephants. Epidemiol Infect 2018; 146:481-488. [PMID: 29397050 PMCID: PMC9134556 DOI: 10.1017/s0950268818000122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/06/2022] Open
Abstract
Tuberculosis (TB) has been known to affect elephants for thousands of years. It was put into spotlight when few circus elephants were diagnosed carrying Mycobacterium (M.) tuberculosis. Because of the zoonotic risk and high susceptibility to M. tuberculosis, periodic testing was enacted since, in captive breeding programmes. Presently, trunk wash is the recommended diagnostic procedure for TB. Trunk wash, however, puts the operator at risk, has low sensitivity, and is prone to contamination. Here, bronchoalveolar lavage is described for the first time for TB diagnosis in elephants. Bronchial, trunk and mouth fluids were investigated using bacterial culture, M. tuberculosis complex (MTC)-specific real-time quantitative PCR (qPCR) and mycobacterial genus-specific qPCR for overall presence of mycobacteria or mycobacterial DNA including bacteria or DNA of closely related genera, respectively, in 14 elephants. Neither bacteria of the MTC nor their DNA were identified in any of the elephants. Yet, 25% of the cultures grew non-tuberculous mycobacteria (NTM) or closely related bacterial species. Furthermore, 85% of the samples contained DNA of NTM or closely related bacterial genera. This finding might explain continued false-positive results from various serological tests. From a zoonotic point of view, bronchoalveolar lavage is safer for the testing personal, has higher probability of capturing MTC and, through PCR, identifies DNA NTM in elephants. Yet, necessary endoscopic equipment, animal sedation and access to a TB reference laboratory might pose challenging requirements in remote conditions in some elephant range countries.
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Affiliation(s)
- R. Hermes
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Alfred-Kowalke-Straße 17, Berlin 10315, Germany
| | - J. Saragusty
- Laboratory of Embryology, Faculty of Veterinary Medicine, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - I. Moser
- Federal Research Institute for Animal Health, Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institute, Naumburger Straße 96a, Jena 07743, Germany
| | - S. Holtze
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Alfred-Kowalke-Straße 17, Berlin 10315, Germany
| | - J. Nieter
- Federal Research Institute for Animal Health, Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institute, Naumburger Straße 96a, Jena 07743, Germany
| | - K. Sachse
- Federal Research Institute for Animal Health, Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institute, Naumburger Straße 96a, Jena 07743, Germany
| | - T. Voracek
- Tierärztliche Ordination Tiergarten Schönbrunn, Seckendorff-Gudent-Weg 6, Vienna A-1130, Austria
| | - A. Bernhard
- Zoo Leipzig GmbH, Pfaffendorfer Str. 29, Leipzig 04105, Germany
| | - T. Bouts
- Park Pairi Daiza, Domaine de Cambron in B-7940 Brugelette, Belgium
| | - F. Göritz
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Alfred-Kowalke-Straße 17, Berlin 10315, Germany
| | - T. B. Hildebrandt
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Alfred-Kowalke-Straße 17, Berlin 10315, Germany
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Saeed DK, Shakoor S, Irfan S, Hasan R. Mycobacterial contamination of bronchoscopes: Challenges and possible solutions in low resource settings. Int J Mycobacteriol 2016; 5:408-411. [DOI: 10.1016/j.ijmyco.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022] Open
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Gopathi NR, Mandava V, Namballa UR, Makala S. A Comparative Study of Induced Sputum and Bronchial Washings in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis. J Clin Diagn Res 2016; 10:OC07-10. [PMID: 27134911 DOI: 10.7860/jcdr/2016/18767.7474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tuberculosis is one of the most important public health problem worldwide. Detecting patients with active pulmonary Koch's disease is an important component of tuberculosis control programs. However, at times in patients even with a compatible clinical picture, sputum smears do not reveal acid-fast bacilli and smear-negative pulmonary tuberculosis remains a common problem. AIM The present study is aimed to compare the results of induced sputum and bronchial washings smear in patients suspected to have sputum smear negative pulmonary tuberculosis. MATERIALS AND METHODS A prospective study conducted from August 2014 to July 2015, comprising 120 patients fulfilling study criteria. Patients with respiratory symptoms and chest roentgenogram suspicious of pulmonary tuberculosis with no previous history of anti-tuberculosis treatment and two spontaneous sputum smear samples negative for acid fast bacilli were included. Patients with active haemoptysis and sputum positive were excluded from the study. Sputum induction was done by using 5-10 ml of 3% hypertonic saline through ultrasonic nebulizer taking safety precautions. All the patient underwent fibreoptic bronchoscopy after six hours fasting on the same day. About 20 ml of normal saline instilled into the suspected pathology area and washings were taken with gentle suction. The sample processing and fluorescent staining for acid fast bacilli was done in a designated microscopy lab. RESULTS Out of 120 sputum smear negative pulmonary tuberculosis patients, induced sputum smear examination detected acid fast bacilli in 76 patients (63.3%) and acid fast bacilli detected from bronchial washings in 94 patients (78.3%). Smear positivity was higher in cavitary and infiltrative lesions as compared to consolidation and infrahilar pattern disease. CONCLUSION Even though both induced sputum and bronchial washings procedures were valuable for the diagnosis of sputum smear negative, sputum induction with hypertonic saline should be the initial procedure of choice, which can be repeated twice / thrice in a day or two consecutive days. If the patient still remains induced sputum smear negative and if the clinical probability of tuberculosis is high, starting anti-tuberculosis treatment and closely monitoring patient and reserving bronchoscopy to those patients who do not improve and to exclude alternative diagnosis seems to be a practically useful approach.
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Affiliation(s)
- Nageswar Rao Gopathi
- Assistant Professor, Department of Pulmonology, Katuri Medical College , Guntur, Andhra Pradesh, India
| | - Venu Mandava
- Assistant Professor, Department of Pulmonology, Katuri Medical College , Guntur, Andhra Pradesh, India
| | - Usha Rani Namballa
- Professor, Department of Pulmonology, Andhra Medical College , Visakhapatnam, India
| | - Sravani Makala
- Assistant Professor, Department of Dermatology, Katuri Medical College , Guntur, Andhra Pradesh, India
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Rao GN, Venu M, Rani NU, Sravani M. Induced sputum versus bronchial washings in the diagnosis of sputum negative pulmonary tuberculosis. J Family Med Prim Care 2016; 5:435-439. [PMID: 27843856 PMCID: PMC5084576 DOI: 10.4103/2249-4863.192336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Tuberculosis (TB) is one of the most important public health problems worldwide. Detecting patients with active pulmonary TB (PT) is an important component of TB control programs. However, at times in patients even with a compatible clinical picture, sputum smears do not reveal acid-fast bacilli (AFB) and smear-negative PT remains a common problem. This study compares the results of induced sputum (IS) and bronchial washings (BWs) in detecting sputum negative PT. Materials and Methods: A prospective study conducted from June 2014 to June 2015, comprising 120 patients fulfilling study criteria. Patients with respiratory symptoms and chest roentgenogram suspicious of PT with no previous history of antiTB treatment (ATT) and two spontaneous sputum smear samples negative for AFB were included in the study. Patients with active hemoptysis and sputum positive were excluded from the study. Sputum induction was done using 5–10 ml of 3% hypertonic saline through ultrasonic nebulizer taking safety precautions. All the patients underwent fiberoptic bronchoscopy after 6 h fasting on the same day. About 20 ml of normal saline instilled into the suspected pathology area and washings were taken with gentle suction. The sample processing and fluorescent staining for AFB were done in a designated microscopy laboratory. Results: Of 120 smear-negative PT patients, IS smear examination detected AFB in 76 patients (63.3%) and AFB detected from BWs in 94 patients (78.5%). Smear positivity higher in cavitary and infiltrative lesions compared to consolidation and infrahilar pattern disease. Conclusions: Even though both IS and BWs procedures were valuable for the diagnosis of smear-negative TB, sputum induction with hypertonic saline should be the initial procedure of choice, which can be repeated twice/thrice in a day or 2 consecutive days. If the patient remains IS smear-negative and if the clinical probability of TB is high, starting ATT and closely monitoring patient and reserving bronchoscopy to those patients who do not improve and to exclude alternative diagnosis seems to be a practically useful approach.
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Affiliation(s)
- Gopathi Nageswar Rao
- Department of Pulmonology, Government Hospital for Chest and Communicable Diseases, Katuri Medical College, Guntur, Andhra Pradesh, India
| | - Mandava Venu
- Department of Pulmonology, Government Hospital for Chest and Communicable Diseases, Katuri Medical College, Guntur, Andhra Pradesh, India
| | - Namballa Usha Rani
- Department of Pulmonology, Government Hospital for Chest and Communicable Diseases, Katuri Medical College, Guntur, Andhra Pradesh, India
| | - Makala Sravani
- Department of Pulmonology, Government Hospital for Chest and Communicable Diseases, Katuri Medical College, Guntur, Andhra Pradesh, India
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Kumar R, Gupta N. Role of bronchoscopy in evaluation of cases with sputum smear negative pulmonary tuberculosis, interstitial lung disease and lung malignancy: A retrospective study of 712 cases. Indian J Tuberc 2015; 62:36-42. [PMID: 25857564 DOI: 10.1016/j.ijtb.2015.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The introduction of flexible bronchoscope has revolutionized the field of pulmonary medicine and is a standard instrument used for diagnostic purpose. A retrospective analysis of the clinico-radiological profile, indication, biopsy procedure and complications, for patients undergoing bronchoscopy at one of the respiratory unit at a tertiary care center in India. METHODS Retrospective analysis of 712 bronchoscopies was done in regard to demographic profile, clinical and radiological presentation and diagnostic indication. The results were analyzed on basis of bronchoscopy inspection and histopathological specimen obtained from transbronchial (TBLB), endobronchial biopsy (EBLB) and cytology specimen by transbronchial needle aspiration (TBNA). Furthermore, diagnostic yield of each biopsy procedure and their combination was evaluated. RESULTS Of 712 patients undergoing bronchoscopy, the pathological diagnosis was achieved in 384 (53.93%). Of 384 diagnosed cases, the clinic-radio-pathological diagnosis of pulmonary tuberculosis in 88 (22.19%), interstitial lung disease (ILDs) in 226 (58.85%), and lung cancer in 70 (18.22%) cases. Of 116 sputum smear negative tuberculosis patients, 88 (75.86%) were diagnosed to be pulmonary tuberculosis; the contribution of BAL being 71.59%. Of 226 ILDs, sarcoidosis was most common 148/226 (65.48%). Among 70 lung cancer diagnosed cases, squamous cell carcinoma was most common (54.28%). CONCLUSION The results from current study reemphasizes on the diagnostic utility as well as safety of the bronchoscopy procedure.
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Affiliation(s)
- Raj Kumar
- Professor and Head of the Department, Department of Respiratory Allergy and Applied Immunology, National Centre of Respiratory Allergy, Asthma and Immunology, V P Chest Institute, University of Delhi, Delhi 110007, India.
| | - Nitesh Gupta
- Resident, Department of Respiratory Allergy and Applied Immunology, V P Chest Institute, University of Delhi, Delhi 110007, India
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Nikbakhsh N, Bayani M, Siadati S. The Value of Bronchoalveolar Lavage in the Diagnosis of Sputum Smear-NegativePulmonary Tuberculosis. IRANIAN JOURNAL OF PATHOLOGY 2015; 10:35-40. [PMID: 26516323 PMCID: PMC4539783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/26/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Sputum smear staining for acid-fast bacilli is initial approach to the diagnosis of pulmonary tuberculosis (PTB) but more than 50% of cases are sputum smear-negative. This study was aimed to investigate the diagnostic value of fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. METHODS This prospective cross-sectional study was carried out on 290 sputum smear-negative patients who were clinically suspicious for PTB in 2006-12. All patients were subjected to FOB andBAL, then BAL specimens stained and cultured. RESULTS Of the 290 patients, 173 cases (59.7%) were men and 117 cases (40.3%) were women with the age of 52.6±19.1 years (ranged 20-76 years). Of the total 290 BAL specimens, 110 specimens (38%) were positive for acid-fast bacilli. Sensitivity, specificity, PPV and NPV was 60%, 91%, 89% and 64%, respectively. Also, LR (+) and LR (-) was 64.6% and 0.44%, respectively. CONCLUSION FOB guided BAL is a reliable, rapid and useful method for establishing the diagnosis of smear negative PTB with minimal complications.
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Affiliation(s)
- Novin Nikbakhsh
- Dept. of Surgery, Babol University of Medical Sciences, Babol, Iran.
| | - Masomeh Bayani
- Infectious and Tropical Disease Research Center, Babol University of Medical Sciences, Babol, Iran.
| | - Sepideh Siadati
- Dept. of Pathology, Babol University of Medical Sciences, Babol, Iran.
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Leutscher P, Madsen G, Erlandsen M, Veirum J, Ladefoged K, Thomsen V, Wejse C, Hilberg O. Demographic and clinical characteristics in relation to patient and health system delays in a tuberculosis low-incidence country. ACTA ACUST UNITED AC 2011; 44:29-36. [DOI: 10.3109/00365548.2011.608081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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