Post-bronchoscopy sputum: Improving the diagnostic yield in smear negative pulmonary TB - 17/09/11
, Meera Mehta a, d , Jaideep Dhariwal a , Aran Singanayagam a , Claire E. Raphael a , Mohammad Salmasi a , David W. Connell a , Philip Molyneaux a , Melissa Wickremasinghe a , Annette Jepson b , Onn Min Kon a, c, ⁎ 
Corresponding author. Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK. Tel.: +44 (0) 2033121344.Summary |
Introduction |
Patients with suspected active Pulmonary Tuberculosis (PTB) who are Acid-Fast Bacilli (AFB) smear negative or non-productive of sputum may undergo bronchoalveolar lavage. However, post-bronchoscopy sputum (PBS) sampling is not routine. The aim of this study was to establish the potential diagnostic value of PBS sampling.
Methods |
A retrospective study of patients attending a London University hospital with microbiologically confirmed PTB between January 2004 and December 2010. Patients who were AFB smear negative or non-productive of sputum were eligible if sputum sampling was performed within 7 days of bronchoscopy.
Results |
Over the study period, 236 patients had microbiologically confirmed smear negative PTB of which 57 patients were eligible for the study. 15 patients (26.3%) were infected with HIV. 19 patients (33.3%) converted to AFB sputum smear positivity post-bronchoscopy and 5 patients (8.8%) were exclusively AFB sputum smear positive on PBS microscopy. Mycobacterium tuberculosis was cultured from the PBS of 43 patients (75.4%) and of these, 4 (7.0%) were exclusively PBS culture positive.
Conclusion |
PBS analysis can provide a simple method of rapidly diagnosing pulmonary tuberculosis. In this cohort, M. tuberculosis culture yield was increased by 7% through PBS sampling. This study has important infection control implications with nearly one third of patients becoming more infectious after bronchoscopy.
Le texte complet de cet article est disponible en PDF.Keywords : Tuberculosis, Post-bronchoscopy sputum, Smear negative, Bronchoscopy, Infection, HIV
Abbreviations : AFB, BAL, HIV, PBS, PTB, TB
Plan
Vol 105 - N° 11
P. 1726-1731 - novembre 2011 Retour au numéro
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