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Indian Journal of Thoracic and Cardiovascular Surgery

Published in:

01-07-2018 | Original Article

Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis

Authors: Satyaprakash Sanjeevaiah, Maruti Yamanappa Haranal, Shashidhar Buggi

Published in: Indian Journal of Thoracic and Cardiovascular Surgery | Issue 3/2018

Abstract

Background

Pulmonary tuberculosis is one of the major health concerns in the developing countries. Isolation of acid-fast bacilli (AFB) or tuberculosis bacilli from the sputum is required for the diagnosis. A proportion of suspected pulmonary tuberculosis (PTB) cases either clinically or radiologically will not produce sputum or will have sputum negative for AFB. These subsets of cases pose a diagnostic challenge to the treating clinicians. In this study, we present our experience and outcomes with flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis.

Materials and methods

This was a prospective cross-sectional study, conducted at SDS Tuberculosis research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India, from 2010 to 2016. A total of 1095 flexible bronchoscopies were done during this period, out of which 180 were patients with sputum negative for AFB, but were strongly suspected to have pulmonary tuberculosis on clinical examination or radiologically. There were 106 males and 74 females. The age ranged between 11 and 68 years. All patients underwent complete evaluation of the tracheobronchial tree followed by bronchoalveolar lavage (BAL). Microbiological studies used were Ziehl-Neelsen (ZN) staining and culture in Lowenstein-Jensen (LJ) medium. Mucosal lesions suspected of tuberculosis were subjected to biopsy and histopathological confirmation. The data was analyzed.

Results

Out of 180 patients, 106 (58.88%) cases had positive AFB smear on BAL. The culture confirmed the diagnosis of pulmonary tuberculosis in 120 cases (66.66%). Histopathology showed caseous granuloma in 38 (42.22%) cases, nonspecific inflammation in 40 (44.44%) cases, and malignancy in 12 (13.33%) cases out of 90 cases, who underwent biopsy. There were no post-procedural complications.

Conclusion

Bronchoscopy is the useful tool in the diagnosis of pulmonary tuberculosis in patients with sputum-negative pulmonary tuberculosis. It is also helpful in differentiating conditions having the clinical picture that mimics pulmonary tuberculosis.

Narain JP.Tuberculosis epidemiology and control. New Delhi: WHO regional office for South-East Asia; 2001:248.

Dye C, Scheele S, Dolin P, Pantania V, Raviglione MC. Global burden of tuberculosis: estimated incidence, prevalence and mortality by country. WHO global surveillance and monitoring project. JAMA. 1999;282:67–86.CrossRef

Quaiser S, Agarwal A, Khan R, Haque SF. Fibreoptic bronchoscopy as a valuable diagnostic option in sputum negative pulmonary tuberculosis. 2012;2:123–7.

Foulds J, O’Brien R. New tools for the diagnosis of tuberculosis: the perspective of developing countries. Int J Tuberc Lung Dis. 1998;2:778–83.PubMed

Kanaya AM, Glidden DV, Chambers HF. Identifying pulmonary tuberculosis in patients with negative sputum smear results. Chest. 2001;120:349–55.CrossRefPubMed

Tozkoparan E, Deniz O, Ciftci F, Bozkanat E, Bicak M, Mutlu H, et al. The roles of HRCT and clinical parameters in assessing activity of suspected smear negative pulmonary tuberculosis. Arch Med Res. 2005;36:166–70.

Mello FC, Bastos LG, Soares SL, Rezende VM, Conde MB, Chaisson RE, et al. Predicting smear negative pulmonary tuberculosis with classification trees and logistics regression: a cross-sectional study. BMC Public Health. 2006;6:43.CrossRefPubMedPubMedCentral

Tattevin P, Casalino E, Fleury L, Egmann G, Ruel M, Bouvet E. The validity of medical history. Classis symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model. Chest. 1999;115:1248–53.CrossRefPubMed

Panda BN, Rajan KE, Jena J, Nema SK, Murali M, Patel AP. Diagnostic yield from flexible fibreoptic bronchoscopy in sputum smear negative pulmonary tuberculosis cases. Indian J Tuberc. 1995;42:207–9.

10.

Mohan A, Sharma SK. Fibreoptic bronchoscopy in the diagnosis of sputum smear negative pulmonary tuberculosis: current status. Indian J Chest Dis Allied Sci. 2008;50:67–78.PubMed

11.

Boras Z, Juretia A, Gagro A, Pavelia LJ. Cytokine profile of T lymphocytes from peripheral blood and bronchoalveolar lavage fluid in patients with active pulmonary tuberculosis. Scand J Immunol. 2007;65:257–64.CrossRefPubMed

12.

Kim TC, Blackman RS, Heatwole KM, Rochester DF. Acid fast bacilli in sputum smears of patients with pulmonary tuberculosis: prevalence and significance of negative smears pretreatment and positive smears post treatment. Am Rev Respir Dis. 1984;29:264–8.

13.

Hong Kong Chest Service, Tuberculosis Research CenLre, Madras, India and British Medical Research Council. -Sputum smears negative pulmonary tuberculosis -controlled trial of 3 months and 2 months regimen of chemotherapy. First report. Lancet, 1979; 1: 1361–1363.

14.

Chawla R, Pant K, Jaggi OP, et al. Fiberoptic bronchoscopy in smear negative pulmonary tuberculosis. Eur Respir J. 1998;1:804–6.

15.

World Health Organization. Global tuberculosis report 2013. WHO/HTM/TB/2013.11.

16.

Samb B, Henzel D, Daley CL, Mugusi F, Niyongabo T, MlikaCabanne N, et al. Methods for diagnosing tuberculosis among in-patients in Eastern Africa whose sputum smears are negative. Int J Tuberc Lung Dis. 1997;1:25–30.

17.

Tessema TA, Bjune G, Assefa G, Bjorvat B. An evaluation of the diagnostic value of clinical and radiological manifestations in patients attending the addis ababa tuberculosis centre. Scand J Infect Dis. 2001;33:355–61.CrossRefPubMed

18.

Lee HM, Shin JW, Kim JY, Park IW, Choi BW, Choi JC, et al. HRCT and whole-blood interferon-gamma assay for the rapid diagnosis of smear-negative pulmonary tuberculosis. Respiration. 2010;79:454–60.

19.

Jayachandra T, Rao PA, Srinivas G, Moorthy NVN, Rao PVP. Fiberoptic bronchoscopy: role of fiberoptic bronchoscopy in smear negative and suspect cases of pulmonary tuberculosis.NTI Bulletin 2006, 42/1&2:12–14.

20.

Araz O, Akgun M, Saglam L, Ozden K, Mirici A. The diagnostic value of bronchoscopy in smear negative cases with pulmonary tuberculosis. Tuberk Toraks. 2008;56:150–7.PubMed

21.

Kulpati DD, Heera HS. Diagnosis of sputum smear negative tuberculosis by flexible bronchoscopy. Indian J Tuber. 1986;33:179–82.

22.

Purohit SD, Sisodia RS, Gupta PR, Sarkar SK, Sharma TN. Fiber optic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis. Lung India. 1983;I:143–6.

23.

Wallace JM, Deutsch AL, Harsell JH, Moser KM. Bronchoscopy and transbrochial biopsy in evaluation of patients with suspected active tuberculosis. Am J Med. 1981;70:1189–94.CrossRefPubMed

24.

Biswas S, Das A, Sinha A, Das SK, Das T. The role of induced sputum in the diagnosis of pulmonary tuberculosis. Lung India. 2003;30:199–202.

25.

Sarkar SK, Sharma TN, Purohit SD, Gupta ML, Gupta PR. The diagnostic value of routine culture of bronchial washings in tuberculosis. Br J Dis chest. 1982;76:358–60.CrossRefPubMed

26.

So SY, Lam WK, Yu DY. Rapid diagnosis of suspected pulmonary tuberculosis by fiber optic bronchoscopy. Tubercle. 1982;63:195–200.CrossRefPubMed

27.

Kvale PA, Johnson MC, Wroblewski DA. Diagnoses of tuberculosis, routine cultures of bronchial washings are not indicated. Chest. 1979;76:140–2.CrossRefPubMed

28.

Danek SJ, Bower JS. Diagnosis of pulmonary tuberculosis by flexible fibreoptic bronchoscopy. Am Rev Respir Dis. 1979;119:677–9.PubMed

29.

Uddenfeldt M, Lundgren R. Flexible fibreoptic bronchoscopy in the diagnosis of pulmonary tuberculosis. Tubercle. 1981;62:197–9.CrossRefPubMed

30.

Pereira W, Kovnat DM, Snider GLA. Prospective cooperative study of complications following flexible fiber optic bronchoscopy. Chest. 1978;73:813–6.CrossRefPubMed

Title: Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis
Authors: Satyaprakash Sanjeevaiah
Maruti Yamanappa Haranal
Shashidhar Buggi
Publication date: 01-07-2018
Publisher: Springer Singapore
Published in: Indian Journal of Thoracic and Cardiovascular Surgery / Issue 3/2018
Print ISSN: 0970-9134
Electronic ISSN: 0973-7723
DOI: https://doi.org/10.1007/s12055-018-0645-z

At a glance: The STEP trials

Springer Medicine

Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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