Document Type : Original Research
Authors
1 Dept. of Surgery, Babol University of Medical Sciences, Babol, Iran.
2 Infectious and Tropical Disease Research Center, Babol University of Medical Sciences, Babol, Iran.
3 Dept. of Pathology, Babol University of Medical Sciences, Babol, Iran
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.
Keywords
- Lange Ch, Mori T. Advances in the diagnosis of tuberculosis. Respirology 2010;15(2):220-40.
- Shin JA, Chang YS, Kim TH, Kim HJ, Ahn CM, Byun MK. Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis. BMC Infect Dis2012;12:141.
- Zumla A, Raviglione M, Hafner R, Von Reyn CF. Tuberculosis. N Engl J Med 2013;368-754-55.
- World Health Organization (WHO) estimates of tuberculosis incidence by rate, 2011(stored by rate) 2013 Available in: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf.
- Boonsarngsuk V, SuwannaphongS, Laohavich CH. Combination of adenosine deaminase activity and polymerase chain in bronchoalveolar lavage fluid in the diagnosis of smear-negative active pulmonary tuberculosis. Int Infect Dis 2012;16(9):663-8.
- Jacomelli M, Silva PRAA, Rodrigues AJ, Demarzo SE, Seicento M, Figueiredo VR. Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results. J Bras Pneumol 2012;38(2):167-73.
- Quaiser S, Agarwal A, Khan R, Haque Sh F. Fiberoptic bronchoscopy, as a valuable diagnostic option in sputum negative pulmonary tuberculosis: A prospective study. Int Appl Basic Med Res 2012;2(2):123-7.
- Kamal R, Sharma R, Sahasrabuddhe T, Dash SK, Showkat M,Gaikwad N. A prospective study to evaluate the utility of bronchoalveolar lavage by fiberoptic bronchoscopy in sputum smear negative patients with high suspicion of pulmonary tuberculosis. Med J Dr.D.Y.Patil Univ 2012;5(1):43-6.
- Yuksekol I, Bal S, Ozkan M, Bedrihan I, Tozkoparan E, Demiric N, et al. The value of fiberoptic bronchoscopy in the diagnosis of smear negative pulmonary tuberculosis. Tuberk Toraks 2003;51(4):405-9.
- Pipatvech K, Kiatboonsri S, Boonsarngsuk V, Hongmanee P, Choothakan S. The value of post-bronchoscopy sputum examination in the diagnosis of smear-negative pulmonary tuberculosis. Thai J Tuberculosis Chest Dis Crit Care 2007:45-50.
- Kalawat U,Sharma KK, Reddy PNR, Kumar AG. Study of bronchoalveolar lavage in clinically and radiologically suspected cases of pulmonary tuberculosis. Lung India 2010;27(3):122-4.
- Mohan A, Sharma SK. Fiberoptic bronchoscopy in the diagnosis of sputum smear-negative pulmonary tuberculosis: current status. Indian J Chest Dis Allied Sci 2008;50(1)67-78.
- Tamura A, Shimada M, Matsui Y, Kawashima M, Suzuki J, Ariga H, et al. The value of fiberoptic broncoscopy in culture-positive pulmonary tuberculosispatients whose pre-bronchoscopic sputum specimens were negative both for smear and PCR analyses. Inter Med 2010;49:95-102.
- Altaf Bachh A, Gupta R, Hag I, Varudkar HG. Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role? Lung India 2010;27(2):58-62.
- Chandra TJ, Dash S, Srinivas G, Prabhakara PV. A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oropharyngeal spacer.J Family Community Med 2012; 19(1):43-6.
- Worodria W, Davis JL, Cattamanchi A, Andama A, Den Boon S, Yoo SD et al. Bronchoscopy is useful for diagnosing smear-negative tuberculosis in HIV-infected patients. Eur Respir J 2010;36:446-56.
- Kumar A, Kumar Gupta A, Haroon Khan M. Role of flexible fiberoptic bronchoscopy in suspected sputum smear negatine pulmonary tuberculosis cases microscopy center under RNTCP. Int J Med Sci public Health 2014;3(1).
- Menon PR, Lodha R, Singh U, Kabra SK. A prospective assessment of the role of bronchoscopy and bronchoalveolar lavage in evaluation of children with pulmonary tuberculosis. J Trop Pediatr 2010 doi:10.1093/tropej.
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