Research Article
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Year 2022, Volume: 8 Issue: 6, 845 - 850, 04.11.2022
https://doi.org/10.18621/eurj.870909

Abstract

References

  • 1. Global Tuberculosis Report 2019. https://www.who.int/tb/global-report-2019. Accessed 27 Jun 2020.
  • 2. Toman K. How many bacilli are present in a sputum specimen found positive by smear microscopy? In: Frieden T. editors. Toman’s Tuberculosis Case detection, treatment, and monitoring – questions and answers, Geneva: World Health Organization; 2004, p. 11.
  • 3. Siddiqi K, Lambert M-L, Walley J. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis 2003;3:288-96.
  • 4. Barnard DA, Irusen EM, Bruwer JW, Plekker D, Whitelaw AC, Deetlefs JC, et al. The utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence setting. BMC Pulm Med 2015;15:103.
  • 5. Bachh A, Gupta R, Haq I, Varudkar HG. Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role? Lung India 2010;27:58.
  • 6. Kacar N, Bıcer B, Tuksavul F, Guclu SZ. [Diagnostic value of bronchial lavage, bronchoalveolar lavage and postbronchoscopic sputum in smear negative pulmonary tuberculosis]. Turkiye Klinikleri Arch Lung 2004;5:200-2. [Article in Turkish]
  • 7. Balbay OA, Calışır HC, Erturk A, Ogretensoy M. [The diagnostic value of bronchial lavage, bronchial biopsy and postbronchoscopic sputum in smear-negative pulmonary tuberculosis]. Tüberküloz ve Toraks Dergisi 2001;49:124-8. [Article in Turkish]
  • 8. Alp AI, Karlikaya C, Hatipoglu ON, Caglar T, Otkun M. [Diagnostic value of fiberoptic bronchoscopy in sputum smear negative pulmonary tuberculosis]. Tüberküloz ve Toraks Dergisi 2002;50:278-87. [Article in Turkish]
  • 9. Willcox PA, Benatar SR, Potgieter PD. Use of the flexible fibreoptic bronchoscope in diagnosis of sputum-negative pulmonary tuberculosis. Thorax 1982;37:598-601.
  • 10. Charoenratanakul S, Dejsomritrutai W, Chaiprasert A. Diagnostic role of fiberoptic bronchoscopy in suspected smear negative pulmonary tuberculosis. Respir Med 1995;89:621-3.
  • 11. Pathakumari B, Prabhavathi M, Anbarasu D, Paramanandhan P, Raja A. Dynamic IgG antibody response to immunodominant antigens of M. tuberculosis for active TB diagnosis in high endemic settings. Clin Chim Acta 2016;461: 25-33.
  • 12. Helb D, Jones M, Story E, Boehme C, Wallace E, Ho K, et al. Rapid detection of mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol 2010;48:229-37.
  • 13. World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system : policy statement. 2011. http://www.ncbi.nlm.nih.gov/books/NBK304235/ Accessed 29 Sep 2020.
  • 14. Chakravorty S, Simmons AM, Rowneki M, Parmar H, Cao Y, Ryan J, et al. The new Xpert MTB/RIF ultra: improving detection of mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. mBio 2017;8:e00812-17.
  • 15. Chan HS, Sun AJM, Hoheisel GB. Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis. Lung 1990;168:215-20.
  • 16. Sanjeevaiah S, Haranal MY, Buggi S. Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis. Indian J Thorac Cardiovasc Surg 2018;34:365-9.
  • 17. Yüksekol İ, Bal Ş, Özkan M, Balkan A, Bedirhan I, Tozkoparan E, et al. [The value of fiberoptic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis]. Tüberküloz ve Toraks Dergisi 2003;51:405-9. [Article in Turkish]
  • 18. Intepe YS, Kıyık M, Tigin HC, Durmaz A, Epozturk K, Cıkrıkcıoglu S. [Diagnostic value acid fast bacilli at BAL in patients who are accepted as clinically and radiologically active tuberculosis with negative sputum smear]. Bozok Med J 2014;4:31-6. [Article in Turkish]
  • 19. Luhadia A, Kapur M, Luhadia SK, Sharma RK. Comparison of induced sputum and fibre-optic bronchoscopy (Fob) in the early diagnosis of sputum smear negative suspected cases of pulmonary tuberculosis under Rntcp settings-A study conducted in southern part of Rajasthan. J Pulm Respir Med 2017;7:1000140
  • 20. Gopathi NR, Mandava V, Namballa UR, Makala S. A comparative study of induced sputum and bronchial washings in diagnosing sputum smear negative pulmonary tuberculosis. J Clin Diagn Res 2016;10:OC07-10.
  • 21. Luo W, Lin Y, Li Z, Shi Y. Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis. BMC Pulm Med 2020;20:146.
  • 22. Tamura A, Shimada M, Matsui Y, Kawashima M, Suzuki J, Ariga H, et al. The value of fiberoptic bronchoscopy in culture-positive pulmonary tuberculosis patients whose pre-bronchoscopic sputum specimens were negative both for smear and PCR analyses. Inter Med 2010;49:95-102.
  • 23. Le Palud P, Cattoir V, Malbruny B, Magnier R, Campbell K, Oulkhouir Y, et al. Retrospective observational study of diagnostic accuracy of the Xpert® MTB/RIF assay on fiberoptic bronchoscopy sampling for early diagnosis of smear-negative or sputum-scarce patients with suspected tuberculosis. BMC Pulm Med 2014;14:137.
  • 24. Khalil KF, Butt T. Diagnostic yield of bronchoalveolar lavage gene Xpert in smear- negative and sputum-scarce pulmonary tuberculosis. J Coll Physicians Surg Pak 2015;25:115-8.
  • 25. Min JW, Yoon HI, Park KU, Song JH, Lee CT, Lee CH. Real-time polymerase chain reaction in bronchial aspirate for rapid detection of sputum smear-negative tuberculosis. Int J Tuberc Lung Dis 2010;14:852-8.
  • 26. Lee HY, Seong MW, Park SS, Hwang SS, Lee J, Park YS, et al. Diagnostic accuracy of Xpert® MTB/RIF on bronchoscopy specimens in patients with suspected pulmonary tuberculosis. Int J Tuberc Lung Dis 2013;17:917-21.
  • 27. Bartlett JG, Alexander J, Mayhew J, Sullivan-Sigler N, Gorbach SL. Should fiberoptic bronchoscopy aspirates be cultured? Am Rev Respir Dis 1976;114:73-8.
  • 28. Danek SJ, Bower JS. Diagnosis of pulmonary tuberculosis by flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1979;119:677-9.
  • 29. Kvale PA, Johnson MC, Wroblewski DA. Diagnosis of tuberculosis: routine cultures of bronchial washings are not indicated. Chest 1979;76:140-2.
  • 30. Schmidt RM, Rosenkranz HS. Antimicrobial activity of aocal anesthetics: lidocaine and procaine. J Infect Dis 1970;121:597-607.

Contribution of bronchoscopic lavage to the diagnosis of smear negative pulmonary tuberculosis

Year 2022, Volume: 8 Issue: 6, 845 - 850, 04.11.2022
https://doi.org/10.18621/eurj.870909

Abstract

Objectives: Sputum acid-fact bacilli (AFB) and Xpert examinations are the most commonly used methods in early diagnosis for pulmonary tuberculosis. It becomes difficult for the clinician to initiate treatment in patients with negative sputum smear and Xpert examinations at the stage of diagnosis. Waiting for culture results for diagnosis causes delay in treatment and increases the risk of disease transmission. We aimed to investigate the contribution of bronchoscopic lavage (BL) obtained with flexible fiberoptic bronchoscopy (FOB) to the diagnosis of tuberculosis.


Methods:
The BL results of 36 patients hospitalized in the tuberculosis clinic who were clinically suspected of tuberculosis, but whose sputum AFB and Xpert results were negative, and whose bronchoscopic lavages were taken by FOB, were retrospectively evaluated.


Results:
BL Xpert examination was the method that made the most contribution to the diagnosis with a rate of 27.7%. BL smear AFB results did not contribute to the diagnosis statistically. Sputum and BL tuberculosis culture results were found to be close to each other. In total, the diagnosis of 50% of the patients was confirmed.

Conclusions: Performing Xpert examinations on bronchoscopic materials of patients with negative sputum examinations significantly increase the rate of early diagnosis.

References

  • 1. Global Tuberculosis Report 2019. https://www.who.int/tb/global-report-2019. Accessed 27 Jun 2020.
  • 2. Toman K. How many bacilli are present in a sputum specimen found positive by smear microscopy? In: Frieden T. editors. Toman’s Tuberculosis Case detection, treatment, and monitoring – questions and answers, Geneva: World Health Organization; 2004, p. 11.
  • 3. Siddiqi K, Lambert M-L, Walley J. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis 2003;3:288-96.
  • 4. Barnard DA, Irusen EM, Bruwer JW, Plekker D, Whitelaw AC, Deetlefs JC, et al. The utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence setting. BMC Pulm Med 2015;15:103.
  • 5. Bachh A, Gupta R, Haq I, Varudkar HG. Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role? Lung India 2010;27:58.
  • 6. Kacar N, Bıcer B, Tuksavul F, Guclu SZ. [Diagnostic value of bronchial lavage, bronchoalveolar lavage and postbronchoscopic sputum in smear negative pulmonary tuberculosis]. Turkiye Klinikleri Arch Lung 2004;5:200-2. [Article in Turkish]
  • 7. Balbay OA, Calışır HC, Erturk A, Ogretensoy M. [The diagnostic value of bronchial lavage, bronchial biopsy and postbronchoscopic sputum in smear-negative pulmonary tuberculosis]. Tüberküloz ve Toraks Dergisi 2001;49:124-8. [Article in Turkish]
  • 8. Alp AI, Karlikaya C, Hatipoglu ON, Caglar T, Otkun M. [Diagnostic value of fiberoptic bronchoscopy in sputum smear negative pulmonary tuberculosis]. Tüberküloz ve Toraks Dergisi 2002;50:278-87. [Article in Turkish]
  • 9. Willcox PA, Benatar SR, Potgieter PD. Use of the flexible fibreoptic bronchoscope in diagnosis of sputum-negative pulmonary tuberculosis. Thorax 1982;37:598-601.
  • 10. Charoenratanakul S, Dejsomritrutai W, Chaiprasert A. Diagnostic role of fiberoptic bronchoscopy in suspected smear negative pulmonary tuberculosis. Respir Med 1995;89:621-3.
  • 11. Pathakumari B, Prabhavathi M, Anbarasu D, Paramanandhan P, Raja A. Dynamic IgG antibody response to immunodominant antigens of M. tuberculosis for active TB diagnosis in high endemic settings. Clin Chim Acta 2016;461: 25-33.
  • 12. Helb D, Jones M, Story E, Boehme C, Wallace E, Ho K, et al. Rapid detection of mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol 2010;48:229-37.
  • 13. World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system : policy statement. 2011. http://www.ncbi.nlm.nih.gov/books/NBK304235/ Accessed 29 Sep 2020.
  • 14. Chakravorty S, Simmons AM, Rowneki M, Parmar H, Cao Y, Ryan J, et al. The new Xpert MTB/RIF ultra: improving detection of mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. mBio 2017;8:e00812-17.
  • 15. Chan HS, Sun AJM, Hoheisel GB. Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis. Lung 1990;168:215-20.
  • 16. Sanjeevaiah S, Haranal MY, Buggi S. Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis. Indian J Thorac Cardiovasc Surg 2018;34:365-9.
  • 17. Yüksekol İ, Bal Ş, Özkan M, Balkan A, Bedirhan I, Tozkoparan E, et al. [The value of fiberoptic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis]. Tüberküloz ve Toraks Dergisi 2003;51:405-9. [Article in Turkish]
  • 18. Intepe YS, Kıyık M, Tigin HC, Durmaz A, Epozturk K, Cıkrıkcıoglu S. [Diagnostic value acid fast bacilli at BAL in patients who are accepted as clinically and radiologically active tuberculosis with negative sputum smear]. Bozok Med J 2014;4:31-6. [Article in Turkish]
  • 19. Luhadia A, Kapur M, Luhadia SK, Sharma RK. Comparison of induced sputum and fibre-optic bronchoscopy (Fob) in the early diagnosis of sputum smear negative suspected cases of pulmonary tuberculosis under Rntcp settings-A study conducted in southern part of Rajasthan. J Pulm Respir Med 2017;7:1000140
  • 20. Gopathi NR, Mandava V, Namballa UR, Makala S. A comparative study of induced sputum and bronchial washings in diagnosing sputum smear negative pulmonary tuberculosis. J Clin Diagn Res 2016;10:OC07-10.
  • 21. Luo W, Lin Y, Li Z, Shi Y. Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis. BMC Pulm Med 2020;20:146.
  • 22. Tamura A, Shimada M, Matsui Y, Kawashima M, Suzuki J, Ariga H, et al. The value of fiberoptic bronchoscopy in culture-positive pulmonary tuberculosis patients whose pre-bronchoscopic sputum specimens were negative both for smear and PCR analyses. Inter Med 2010;49:95-102.
  • 23. Le Palud P, Cattoir V, Malbruny B, Magnier R, Campbell K, Oulkhouir Y, et al. Retrospective observational study of diagnostic accuracy of the Xpert® MTB/RIF assay on fiberoptic bronchoscopy sampling for early diagnosis of smear-negative or sputum-scarce patients with suspected tuberculosis. BMC Pulm Med 2014;14:137.
  • 24. Khalil KF, Butt T. Diagnostic yield of bronchoalveolar lavage gene Xpert in smear- negative and sputum-scarce pulmonary tuberculosis. J Coll Physicians Surg Pak 2015;25:115-8.
  • 25. Min JW, Yoon HI, Park KU, Song JH, Lee CT, Lee CH. Real-time polymerase chain reaction in bronchial aspirate for rapid detection of sputum smear-negative tuberculosis. Int J Tuberc Lung Dis 2010;14:852-8.
  • 26. Lee HY, Seong MW, Park SS, Hwang SS, Lee J, Park YS, et al. Diagnostic accuracy of Xpert® MTB/RIF on bronchoscopy specimens in patients with suspected pulmonary tuberculosis. Int J Tuberc Lung Dis 2013;17:917-21.
  • 27. Bartlett JG, Alexander J, Mayhew J, Sullivan-Sigler N, Gorbach SL. Should fiberoptic bronchoscopy aspirates be cultured? Am Rev Respir Dis 1976;114:73-8.
  • 28. Danek SJ, Bower JS. Diagnosis of pulmonary tuberculosis by flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1979;119:677-9.
  • 29. Kvale PA, Johnson MC, Wroblewski DA. Diagnosis of tuberculosis: routine cultures of bronchial washings are not indicated. Chest 1979;76:140-2.
  • 30. Schmidt RM, Rosenkranz HS. Antimicrobial activity of aocal anesthetics: lidocaine and procaine. J Infect Dis 1970;121:597-607.
There are 30 citations in total.

Details

Primary Language English
Subjects Respiratory Diseases
Journal Section Original Articles
Authors

Mustafa Engin Şahin 0000-0002-2707-8196

Sertan Bulut 0000-0003-1267-3440

Publication Date November 4, 2022
Submission Date January 30, 2021
Acceptance Date January 24, 2022
Published in Issue Year 2022 Volume: 8 Issue: 6

Cite

AMA Şahin ME, Bulut S. Contribution of bronchoscopic lavage to the diagnosis of smear negative pulmonary tuberculosis. Eur Res J. November 2022;8(6):845-850. doi:10.18621/eurj.870909

e-ISSN: 2149-3189 


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