Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis
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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.
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.
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.
KeywordsTuberculosis AFB Sputum negative
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Narain JP.Tuberculosis epidemiology and control. New Delhi: WHO regional office for South-East Asia; 2001:248.Google Scholar
- 3.Quaiser S, Agarwal A, Khan R, Haque SF. Fibreoptic bronchoscopy as a valuable diagnostic option in sputum negative pulmonary tuberculosis. 2012;2:123–7.Google Scholar
- 6.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.Google Scholar
- 9.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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 14.Chawla R, Pant K, Jaggi OP, et al. Fiberoptic bronchoscopy in smear negative pulmonary tuberculosis. Eur Respir J. 1998;1:804–6.Google Scholar
- 15.World Health Organization. Global tuberculosis report 2013. WHO/HTM/TB/2013.11.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 21.Kulpati DD, Heera HS. Diagnosis of sputum smear negative tuberculosis by flexible bronchoscopy. Indian J Tuber. 1986;33:179–82.Google Scholar
- 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.Google Scholar
- 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.Google Scholar