Avaliação da utilidade diagnóstica da fibrobroncoscopia óptica na tuberculose pulmonar BAAR negativa na prática clínica de rotina

Abstract

We evaluated the diagnostic yield of fiberoptic bronchoscopy for the diagnosis of smear-negative pulmonary tuberculosis in patients treated at a referral hospital in Lima, Peru. Of the 611 patients who underwent the procedure, 140 (23%) were diagnosed with tuberculosis based on the analysis of BAL samples. Being young and being male were significantly associated with positive cultures. In addition, 287 patients underwent postbronchoscopic sputum smear testing for AFB, the results of which increased the diagnostic yield by 22% over that obtained through the analysis of BAL samples alone. We conclude that the analysis of BAL samples and post-bronchoscopic sputum samples provides a high diagnostic yield in smear-negative patients suspected of having pulmonary tuberculosis.Keywords: Tuberculosis, pulmonary/diagnosis; Bronchoscopy; Sputum. ResumoAvaliamos o rendimento diagnóstico da fibrobroncoscopia óptica no diagnóstico de tuberculose pulmonar BAAR negativa em pacientes atendidos em um hospital de referência em Lima, Peru. Dos 611 pacientes submetidos ao procedimento, 140 (23%) foram diagnosticados com tuberculose com base nas amostras de LBA. Ser mais jovem e do sexo masculino foi associado a culturas positivas. Além disso, 287 pacientes tiveram baciloscopia de escarro após a broncoscopia, e os resultados aumentaram o rendimento diagnóstico em 22% em relação às amostras de lavado. Concluímos que amostras de lavado brônquico e de escarro pós-broncoscopia tiveram um bom rendimento diagnóstico nos pacientes com suspeita de tuberculose pulmonar BAAR negativa.Descritores: Tuberculose pulmonar/diagnóstico; Broncoscopia; Escarro.

Main findings and diagnostic yield of bronchoalveolar lavage, bronchial brushing and transbronchial biopsy in HIV-positive patients

“…The frequency of pneumocystis pneumonia, nocardiosis and fungal infections was much higher in our study, totaling 21.86%, compared to that reported by others 8 for the same reason, i.e., we selected HIV-immunosuppressed patients who are known to have a higher frequency of these opportunistic infections. In a study carried out in a referral hospital in Lima, Peru 7 , the authors have also found a higher frequency of tuberculosis (23%) in the studied bronchoalveolar lavage samples. The patients of that study were also selected based on clinical suspicions of tuberculosis.…”

“…Another important point is the technique used for the diagnosis. We performed the direct search of microorganisms in liquid or tissue samples through special staining methods such as Fite Faraco and Ziehl-Neelsen; other authors used culture and/or PCR techniques to search for etiological agents, thus increasing the chances of reaching a diagnosis 7,8 .…”

“…Within this context, fiberoptic bronchoscopy using sampling methods such as bronchoalveolar lavage, bronchial brushing and transbronchial biopsy are of fundamental importance for the integrated work-up of HIV-infected patients 6 . Depending on the clinical suspicion and through the correlation with radiological data, the identification of etiological agents becomes crucial for the adequate treatment and prognosis of these patients 7 .…”

Unusual Clinical Presentation of Thoracic Tuberculosis: The Need for a Better Knowledge of Illness

“…Usually, it is thought that microbiological examination of bronchial aspirate and BAL are positive for Mycobacterium tuberculosis in patients with EBTB, and that examination provides a good diagnostic yield [ 14 ]. A study conducted by Ozkaya et al highlights the difficulty of the bacteriological diagnosis of EBTB based on BAL analysis, bronchial aspirate, or sputum analysis, and showed that a high diagnostic yield was obtained through the histopathologic examinations of bronchial biopsies, confirmed in our clinical case [ 15 ].…”