Title: A Comparison of yield of bronchoalveolar lavage fluid examination versus post bronchoscopic sputum examination in the diagnosis of sputum smear negative pulmonary tuberculosis

Authors: Durga Prasad Singh, Vivek Kumar Verma, Premshanker Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.182

Abstract

Aim: To compare efficacy/yield of post bronchoscopic sputum (PBS) with Bronchoalveolar lavage (BAL) in the detection of sputum smear negative pulmonary tuberculosis (SSNPTB).

Material and Methods: Bronchoscopy was done in 72 patients of SSNPTB .BAL and Post Bronchoscopy Sputum (PBS) were collected and subjected to AFB staining and culture.

Results: Tuberculosis was confirmed by smear examination for AFB in BAL fluid in 30 cases (41.6%), by post bronchoscopy sputum in 18 cases (25%). BAL culture for M. tuberculosis was positive in 37(51.3%) patients whereas PBS culture was positive in 23 (32%) patients. We were able to diagnose 39 out of 72 cases (54.2%) by combining both BAL fluid and PBS smear examination and culture for AFB. Out of these 39 cases diagnosed, BAL was more effective method with sensitivity of 94.87 % and yield of 51.38% (37/72) whereas sensitivity and yield of PBS was 58.97% and (23/72) 31.94% respectively.

Conclusions: Patients of SSNPTB must be subjected to bronchoscopy and its guided procedures before starting empirical antitubercular treatment. In our study Bronchoalveolar lavage had more sensitivity and yield as compared to post bronchoscopy sputum in detection of SSNPTB.

Keywords: Bronchoalveolar lavage fluid, Bronchoscopy, Post bronchoscopic sputum, Sputum smear negative pulmonary tuberculosis                

References

  1. http://www.who.int/tb/publications/global_report/en/
  2. Park K.: Park’s Textbook of preventive and social medicine; 23rd Epidemiology of communicable diseases. Banarsidas bhanot publishers, Jabalpur; 2015: 176-202.
  3. http://tbcindia.nic.in/index
  4. Mukhopadhyay S., Seith A., Roentgeno-graphic manifestations of pulmonary tuberculosis. In: Sharma S.K., Mohan A, editors: Tuberculosis; 2nd; Jaypee brothers medical publishers, New delhi;2009.200-215.
  5. Crofton J, Seaton A et al: Crofton and Douglas's Respiratory Diseases; Oxford: Blackwell; 2000.
  6. WHO Technical Report Series; No 552; ninth report of WHO Expert Committee on Tuberculosis; Geneva; World Health Organization; 1974.
  7. Behrr M A, Warren SA,Salamon HHopewell PCPonce de Leon ADaley CL et al: Transmission of Mycobacterium Tuberculosis from patients smear- negative for acid fast bacillus. Lancet 1999; 353: 444-9.
  8. Hong Kong Chest Service/ Tuberculosis Research Centre Madras/ British Medical Research Council, Sputum Smear Negative Tuberculosis, Controlled clinical trial of 3- months and 2-months regimen of chemotherapy, Lancet 1979; 1: 1361-3.
  9. Hong Kong Chest Service/ Tuberculosis Research Centre Madras/ British Medical Research Council, A study of course and characteristics of sputum smear negative pulmonary tuberculosis. Tubercle 1981; 62: 155-67.
  10. D.,SisodiaR.S.,GuptaP.R.,SarkarS.K.,SharmaT.N.:Fiberoptic Bronchoscopy In Diagnosis Of Smear Negative Pulmonary Tuberculosis. Lung India1983; 1(4): 143-46.
  11. Kulpati D.D.S. and Heera H.S.: Diagnosis of smear negative pulmonary tuberculosis by flexible fiberoptic bronchoscopy. J. Tub. 1986; 33: 179-182.
  12. Bachh A A, Gupta R., haq I, Varudkar HG: Diagnosing sputum smear negative pulmonary tuberculosis: Does fibreoptic bronchoscopy play a significant role?. Lung India 2010; 27(2): 58-62.
  13. X Qingliang and W Jianxin: Investigation of endobronchial tuberculosis diagnoses in 22 cases. European Journal of Medical Research2010; 15:309
  1. Jain S R K, Arun B.J.Paramjyothi G. K: Role of Fiberoptic Bronchoscopy In Patients with Sputum Smear Negative for Acid Fast Bacilli and Chest X-Ray Suggestive of Pulmonary Tuberculosis. J of Evidence Based Med &Hlthcare 2015; 2(2): 155-164.
  2. Choudhary S, TayadeBO ,Kharbade S, Sontakke A, Khan S, Abraham R: Outcome of fiber optic bronchoscopy in sputum smear negative pulmonary tuberculosis. Panacea Journal of Medical Science, 2015; 5(1): 33-39.
  3. Charoenratanakul S, Dejsomritrutai W,Chaiprasert A: Diagnostic role of fibreoptic bronchoscopy in suspected smear negative pulmonary tuberculosis.Respiratory Medicine 1995; 89: 621-623.
  4. Malekmohammad M., Marjani M, Tabarsi P, Baghaei P, Sadr Z, Naghan PA et al: Diagnostic yield of post-bronchoscopy sputum smear in pulmonary tuberculosis. Scand J Infect Dis 2012; 44(5): 369-373.
  5. Quaiser S., AgarwalA.,Khan R., Haque SF: Fiberoptic bronchoscopy, as a valuable diagnostic option in sputum negative pulmonary tuberculosis: A Prospective International Journal of Applied and Basic Medical Research 2012; 2(2): 123–127.
  6. Balakrishna J., Shahapur P.R., Chakradhar. P., Sreedevi.S., Saheb SK: Role of Fiberoptic Bronchoscope in Sputum Smear Negative, Radiological Suspect Cases of Pulmonary Tuberculosis. J.Pharm. Sci. & Res. 2015; 7(4): 231-233.
  7. So S.Y., Lam W.K., Yu DYC: Rapid diagnosis of suspected pulmonary tuberculosis by fibreopticbronchoscopy. Tubercle1982; 63(3): 195-200.
  8. Gracia J.de, CurullV.,Vidal R.,Riba A.,OrriolsR.,Martin N: Diagnostic value of bronchoalveolar lavage in suspected pulmonary tuberculosis. Chest 1988; 93(2): 329-332.
  9. Pipatvech K., Kiatboonsri S., Boonsar-ngsuk V.,Hongmanee P. , Choothakan S: The value of post bronchoscopic sputum examination in the diagnosis of smear negative pulmonary tuberculosis. Thai Journal of Tuberculosis Chest Diseases and Critical Care. 2007: 45-50.

Corresponding Author

Dr Vivek Kumar Verma

Lecturer, Dept of Medicine, UPUMS, Saifai, Etawah (UP) - 206130

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: +919450865362