Keywords : fibreoptic bronchoscopy
BRONCHOSCOPIC INTERVENTION AND MOLECULAR DIAGNOSTICS: SYNERGISTIC TOOLS IN A PULMONOLOGIST’S ARMAMENTARIUM AGAINST TUBERCULOSIS
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 4, Pages 2300-2311
Background: Mycobacterium tuberculosis complex is the causative organism of tuberculosis, it is a major health problem throughout the world. In developing countries like India, almost 25% of adult deaths which are avoidable are caused by it.
Around 22-61% of Cases have smear negative but culture positive state where clinical profile and radiological lesions suggest diagnosis of pulmonary tuberculosis, then initiation of anti-tubercular drugs is not advisable without meticulous search for tubercular bacilli.
Gold standard for diagnosis of tuberculosis is culture of sputum, but it takes long time( 45 days ) to perform.
Aim: Evaluation of bronchoalveolar lavage fluid in clinically and radiologically suspected cases of sputum smear negative pulmonary tuberculosis.
Methodology: In our observational, cross sectional study done in the Department of Respiratory Medicine, NIMS involving all the patients attending indoor and outdoor services in one year period from January 2019 to June 2020, we tried to access the diagnostic yield of bronchoalveolar lavage fluid in clinically and radiologically suspected cases of sputum smear negative pulmonary tuberculosis. Then the Broncholaveolar Lavage (BAL) fluid specimen was sent for smear for AFB, CBNAAT and BACTEC culture for Mycobacterium tuberculosis.
Result: In this study, pulmonary infiltrate (54.2 %) was most common radiological finding in their chest x-ray, followed by cavity (31.2%). 17 patients had nodular shadow (8.9%) and only 11 patients had miliary pattern (5.7%). Out of 190 cases, 156 patients had unilateral involvement of lung (82.2%) and only 34 cases had bilateral involvement (17.8%). Most of the patients had right upper zone (58.4%) involvement followed by left upper zone (12.2%) with involvement of lower lung field in only 4.2%.
Conclusion: To conclude bronchoalveolar lavage obtained by fiber optic bronchoscopy is a relatively safe and useful procedure for diagnosis of suspected pulmonary tuberculosis cases when smears of these patients does not reveal mycobacterium tuberculosis.