Title: The Role of Bronchoscopy in the Diagnosis of Sputum Smear Negative Pulmonary Tuberculosis
Authors: Vikash Gupta, Anurag Agrawal, Lalit Singh, Rajeev Tandon
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.30
Abstract
Introduction: Diagnosis of sputum/smear-negative pulmonary tuberculosis patients can be both challenging and time consuming with many patients being put on empirical anti-tubercular treatment. Bronchoscopy may provide a confirmative and early diagnosis in such patients.
Aims And Objective: To assess the role of fibreoptic bronchoscopy in patients with suspected pulmonary tuberculosis who have no or inadequate sputum or have a sputum smear negative for acid fast bacillus (AFB) on two samples as per RNTCP 2013 guidelines.
Materials And Methods: The study was conducted in department of Pulmonary Medicine, SRMS Institute of Medical Science, Bareilly from 1st Jan 2015 to 31st Dec 2015. Fourty six patients with clinical and radiolo-gical evidence of pulmonary TB with no or inadequate sputum or smear negative for AFB on two samples were studied. Fibreoptic bronchoscopy was performed; bronchial washings and bronchial brush was taken. The specimens were subjected to Ziehl Neelsen staining and were examined under oil immersion lens for the presence of AFB.
Results: In suspected cases of sputum smear negative pulmonary tuberculosis, the diagnosis of tuberculosis (smear positive) was established in 23 (50%) patients in bronchial brush and 21 (45.7%) patients were positive in bronchial wash, highlighting its role in diagnosis of pulmonary tuberculosis. Patients were followed up after 6 months and those positive for AFB responded well to ATT.
Conclusion: Bronchoscopy is a useful tool in diagnosis of pulmonary tuberculosis in sputum smear negative patients. Bronchoscopy reveals a higher bacteriological confirmation of diagnosis in patients with strong clinical and radiological evidence suggestive of pulmonary tuberculosis and those having more risk factors.
Keywords: Bronchoscopy, pulmonary tuberculosis, sputum smear negative.
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