The Value Of Flexible Bronchoscopy In The Diagnosis Of Sputum-negative Pulmonary Tuberculosis

The incidence of the tuberculosis presents the up-trend inrecent years. Although mycobacterial culture positivity is thegold standart for the diagnosis, the approach to the diagnosisof pulmonary tuberculosis is the detection of acid-fast bacilli(AFB) in respiratory specimens as recommended by the WorldHealth Organization, but their positive rate are low. Patientssuspected of having active pulmonary tuberculosis, in whomacid-fast bacilli (AFB) are not demonstrated on sputum directsmear, present a difficult diagnostic and therapeutic problem.Flexible bronchoscopy is a useful procedure in evaluating thesepatients.Objective: To valuate the diagnostic value of flexiblebronchoscope in the diagnosis of sputum-negative pulmonarytuberculosis.Methods: 65 patients were recruited to the study. Allpatents (1)were clinically suspected of having activetuberculosis; (2)showed abnormal chest roentgenogramsuggesting tuberculosis; (3)showed negative sputum smear ofacid-fast bacilli, or had no sputum. All patients underwentflexible bronchoscopy examination by protected specimenbrush(PSB),protected bronchoalveolar lavage(PBAL),transbronchial biopsy (TBB), specimen brush(SB) andpostbronchoscopy sputum smear(PBS). The specimen of thePSB and PBAL was examined by detection of acid-fast bacilli(AFB) and Lowenstein-Jensen culture, and in later 36 casesBACTEC rapid culture technique. TBB tissue specimen wassent for histological examination.Results: The results of the study were summarized asfollows : 1.Smear of PBAL,PSB,SB,PBS acid-fast bacillipositive was 13,7,7,8 respectively. 2.In 65 patients ,PBALLowenstein-Jensen culture positivity was 32.31%(21 patients)and PSB was 12.31%(8 patients).In later 36 patients we usedBACTEC MGIT 960 rapid culture technique, the PBAL andPSB culture positivity was 61.11% and 25% respectively. 3.Histopathological results confirmed tuberculosis in 37 of 65patients who had undergone Transbronchial biopsies,20 of 40 ofmucosal biopsies,17of 25 of TBLB. 4.The diagnostic yield ofoverall bronchoscopic procedures for tuberculosis in this studywas 76.92%(50/65)of patients,positive for myobacterial L-Jculture in 32.31%(21/65)of patients and histologically positivein 56.92%(37/65) of patients.Conslusion:1. flexible bronchoscopy has an important role inthe diagnosis of patients suspected to have tuberculosis, whosesputum smears were negative or who could not produce sputum.2. Transbronchial biopsy has a major role for early diagnosisand should be performed in all cases, if possible.3. Performanceof BALshould be reutine since this simple and usually...