Role of Bronchoscopy in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis

  • Prashant Prakash Associate Professor & Incharge Pulmonary Medicine Unit, Department Of Medicine, S.N. Medical College, Agra
  • Pooja Agarwal
  • Prabhat Agarwal
  • Durga Prasad Singh
  • Ashutosh Gupta
Keywords: BAL, Bronchoscopy, PBS, SSNPTB, TBLB

Abstract

Background - In patients of pulmonary tuberculosis microscopic examination of sputum is the method of choice. Sputum examination for AFB microscopy is usually positive but even in advanced disease may be negative due to immunosuppression, poor quality of the sample collection, deficient preparation, staining or examination of the sputum smear. Clinical and radiological based diagnosis can lead either to over or under diagnosis of tuberculosis and unnecessary antitubercular treatment may cause drug resistance and economic burden. Fiberoptic bronchoscopy can provide excellent material for diagnosis of suspected cases of pulmonary tuberculosis when smears of expectorated sputum do not reveal mycobacteria.Aim - To assess the role of bronchoscopy in diagnosis of pulmonary tuberculosis among patients who have clinico-radiological suspicion but remain negative for AFB on sputum examination.Settings and design - After consent, 50 patients with sputum smear negative for AFB and chest X-ray suggestive of pulmonary tuberculosis, underwent fiberoptic bronchoscopy. Bronchoalveolar lavage (BAL), Bronchial brushings, Transbronchial lung biopsy (TBLB) and Post bronchoscopy sputum (PBS) were done and samples analyzed by smear microscopy, histopathology and or culture.  Result - Sensitivity of BAL, Brushing and PBS by smear and culture are 87.5%, 54.17% and 50% respectively. The final diagnosis of PTB was established in 24/50 (48%) cases.Conclusion - Fiberoptic bronchoscopy with post bronchoscopy sputum is a useful tool for diagnosis and can thereby prompt treatment of sputum smear negative pulmonary tuberculosis patients.

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Published
2016-03-10
Section
Original Article