Bronchoscopy with bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis

Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis

Background

Pulmonary tuberculosis is one of the most common infectious diseases worldwide. Patients with suspected pulmonary tuberculosis with negative smear are recommended to undergo further tests including sputum induction and bronchoscopy. Our study is aimed to compare sputum induction and bronchoscopic specimens in the diagnosis of sputum smear-negative pulmonary tuberculosis.

Method

PubMed, Web of Science, Cochrane Library and Embase were searched for eligible studies. The pooled sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and 95% confidence intervals (CI) were constructed, and the areas under the curves (AUCs) were calculated.

Results

Five studies with a total number of 586 cases were included. For mycobacterial culture, the SEN and SPE of sputum induction were 0.72(95% CI, 0.66–0.77) and 1.00(95%CI, 0.99–1.000) respectively, whereas the SEN and SPE of bronchoscopy were 0.70(95%CI, 0.64–0.75) and 1.00(95%CI, 0.99–1.00) respectively. Sputum induction had a similar AUC (0.9564, SE = 0.0749) with bronchoscopy (0.8618, SE = 0.1652) (P = 0.602). For specimen of acid-fast bacilli smear, the SEN and SPE of sputum induction were 0.35(95% CI, 0.29–0.42) and 0.99(95% CI, 0.96–1.00) respectively, whereas the SEN and SPE of bronchoscopy were 0.38(95% CI, 0.32–0.45) and 0.99(95% CI, 0.96–1.00) respectively. There is no statistically significant difference in the AUC for sputum induction (0.6016) compared with bronchoscopy (0.8163) (P = 0.792).

Conclusions

For the diagnosis of sputum smear-negative pulmonary tuberculosis, the diagnosis yield of sputum induction and bronchoscopy is similar.

Comparison of bronchoscopic washing and gastric lavage in the diagnosis of smear-negative pulmonary tuberculosis

OBJECTIVE

To evaluate the diagnostic contribution and utility of bacteriologic surveys using bronchoscopic washing and gastric lavage in cases of radiologically suspected tuberculosis with no detectable acid-fast bacilli (AFB) in the sputum.

MATERIAL AND METHODS

This prospective study performed bronchoscopic lavage following gastric washing in suspected pulmonary tuberculosis patients. The presence of AFB was determined via direct microscopy and materials were cultured in Löwenstein-Jensen medium.

RESULTS

Thirty-eight consecutive patients were enrolled in the study (30 males and 8 females; mean age, 33.8 +/- 10.9 years). Three patients could not give sputum. In 23 of 35 cases (66%), sputum cultures (SC) were positive. In 17 cases (49%), gastric lavage cultures (GLC) were positive. Eighteen cases (55%) had positive bronchoscopic washing cultures (BWC). No statistically significant difference was observed when SC positivity was compared to GLC and BWC, and no difference was observed when the GLC results were compared with BWC. Tuberculosis was confirmed in 30 of 38 (79%) patients when SC and GLC were evaluated together, in 33 of 38 patients (87%) when SC and BWC were evaluated together, and in 36 of 38 (95%) when SC, GLC, and BWC were evaluated together (P = 0.016, P = 0.002, and P = 0.0001, respectively). The increase in positive cultures was statistically significant when gastric lavage was evaluated together with bronchoscopic washing (P = 0.004).

CONCLUSION

Adding gastric lavage and bronchial washing to sputum culture could increase culture positivity for M tuberculosis bacilli in suspected pulmonary tuberculosis patients with AFB-negative sputum smears.

Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis

Bronchial artery embolization (BAE) is the treatment of choice in the majority of patients with severe hemoptysis. However, this procedure may be unavailable and even fail or be counterindicated in 4-13% of cases. In these cases, the efficacy of fibrinogen-thrombin (FT) instilled endoscopically as treatment for massive hemoptysis was assessed. Between August 1993 and February 1996 a prospective clinical study was performed. FT instillation was indicated in all patients with severe hemoptysis (> 150 ml/12 h) in whom BAE had failed, was counterindicated or not available. FT was instilled endoscopically. Patients were followed up until June 2001. Eleven of 101 patients (11%) with hemoptysis > 150 ml/12 h in whom BAE was not possible or proved ineffective were included. The severe hemoptysis was controlled immediately in all cases. During the follow-up period (mean: 39.4 months), early relapse of the severe hemoptysis occurred in two patients (18%) and a long-time relapse in one. Mean procedure duration was 3 min and no attributable complications were observed in any case. In conclusion, these results suggest that topical treatment with FT could be considered in the initial endoscopic evaluation of patients with severe hemoptysis while awaiting BAE or surgery, or as alternative treatment to arterial embolization when the latter is not available, has proved ineffective or is counterindicated.

[The efficacy of bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis]

In order to analyze the usefulness of bronchoalveolar lavage (BAL) for conventional microbiological diagnosis of tuberculosis (TB) and other mycobacteria, and to assess the need to use it or not as a routine diagnostic technique in these diseases, we studied 30 patients with mycobacteria (26 TB and 4 Mycobacterium avium-intracellulare infections) by bronchoscopy, with BAL and bronchoaspirate (BAS) bacteriological analyses also available. The results were compared with those obtained for sputum taken before and after bronchoscopy when these specimens were available. The overall yield for BAL and BAS cultures was 90%, with BAL (83.3%) specimens being more productive than BAS (73.3%) specimens. Both performed far better than the 53.8% recorded for cultures of pre-bronchoscopy sputum and 60% for post-bronchoscopy sputum. BAL was the only diagnostic specimen from 7 patients, while BAS the only one from 4. Sensitivity was similar for the two mycobacteria studied. The results for direct bacilloscopy, however, at 30% for the two specimens, rose to 36.6% when they were analyzed together with BAS and BAL. We conclude that bronchoscopy should be performed on all patients suspected of mycobacterial infection when sputum bacilloscopy is negative and patients have no expectoration. Performance of BAL should be routine since this simple and usually uncomplicated technique produces the most productive specimens.