International Journal For Multidisciplinary Research

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Diagnostic Value of Bronchoscopy in Sputum‑negative Presumptive Pulmonary Tuberculosis Patients and Its Clinicoradiological Profile

Author(s) OJHA SAURABH GHANSHYAM, VED PRAKASH, PULKIT GUPTA, ANIL MAURYA, SHUBHAM TIWARI
Country India
Abstract CONTEXT: Tuberculosis (TB) remains endemic in India. Little local data have been reported on bronchoscopic evaluation of sputum‑negative pulmonary TB patients, which poses a significant diagnostic and therapeutic challenge.
AIMS: To determine the diagnostic value of bronchoscopy and bronchoalveolar lavage (BAL) and its clinical and radiological profile in sputum‑negative, pulmonary TB patients.
METHODS: We performed an analysis of patients with probable pulmonary TB with overall negative (smear and/or polymerase chain reaction [PCR]) or scanty sputum that had undergone bronchoscopy with BAL over a period of 11 months. Patients’ symptoms, radiological features, lung lobe lavaged, BAL acid‑fast bacilli (AFB) stain, Mycobacterium TB (MTB)‑PCR, and mycobacterial cultures were analyzed. Mycobacterial culture was used as a reference standard.
RESULTS: 54 patients underwent a diagnostic bronchoscopy. Dry cough and fever were the most common symptoms. Uncontrolled diabetes mellitus was the most frequent comorbidity identified in 15 (28%) patients. Fifty‑nine percent of the patients had diffuse lung infiltrates, with consolidation being the most common abnormality (41%), followed by cavitation (39%). Right upper lobe was the most frequent lung lobe lavaged (31%). BAL mycobacterial culture and MTB Polymerase Chain Reaction (PCR) were positive in 43 (80%) and 41 (76%) patients and BAL AFB was positive in 5 patients respectively. Using BAL culture as reference, male gender, predominant upper lobe disease, upper lobe lavage, and presence of cavities on chest imaging had the highest diagnosticyield (82%, 100%, 63%, and 89%, respectively) (P = 0.02,0.006, 0.03, and 0.02, respectively).There was 100% concordance among the three diagnostic modalities.
CONCLUSIONS: An overall diagnostic yield of 80% was achieved with combined use of BAL MTB PCR, culture, and AFB staining.
Keywords: Broncho alveolar lavage, bronchoscopy, Mycobacterium tuberculosis polymerase chain reaction, sputum negative, tuberculosis
Keywords Broncho alveolar lavage, bronchoscopy, Mycobacterium tuberculosis polymerase chain reaction, sputum negative, tuberculosis
Field Medical / Pharmacy
Published In Volume 5, Issue 6, November-December 2023
Published On 2023-12-09
Cite This Diagnostic Value of Bronchoscopy in Sputum‑negative Presumptive Pulmonary Tuberculosis Patients and Its Clinicoradiological Profile - OJHA SAURABH GHANSHYAM, VED PRAKASH, PULKIT GUPTA, ANIL MAURYA, SHUBHAM TIWARI - IJFMR Volume 5, Issue 6, November-December 2023. DOI 10.36948/ijfmr.2023.v05i06.10202
DOI https://doi.org/10.36948/ijfmr.2023.v05i06.10202
Short DOI https://doi.org/gs8db3
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