Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD® Gen-probe testing

Iyer, Vivek N.; Joshi, Avni Y.; Boyce, Thomas G.; Brutinel, M.; Scalcini, M; Wilson, John W.; Mccoy, Kevin; Aksamit, Timothy R.

doi:10.1016/j.rmed.2011.03.003

Cited by 23 publications

(29 citation statements)

References 38 publications

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“…However, bronchoscopy has an integral part in the diagnosis of negative smear MTB patients. Previous studies revealed a wide range of bronchoscopy diagnostic yield in negative smear TB patients, which was reported as low as 10% [ 17 - 18 ]. In our study, MTB diagnosis was confirmed in 37.7%, higher than previous studies, yet lower than reported by Alzeer et al (67%) [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

Qanash¹,

Hakami²,

Al-Husayni³

et al. 2020

Cureus

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Objective Flexible fiberoptic bronchoscopy (FFB) has become an essential procedure for diagnosing and managing various respiratory conditions. We aimed to assess the main indications, diagnostic yield, and safety of FFB in our institute. Methods A total of 216 patients who underwent FFB between July 2009 and June 2012 at King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, were reviewed retrospectively. Indications of the procedure, the diagnostic yield of variable respiratory diseases, and complications were reported. Result Out of 216 patients, 210 (97.2%) completed FFB. One hundred and ninety-eight (91.7%) bronchoscopies were for diagnostic purposes, and the remaining 12 (5.6%) were for therapeutic aim. The mean age of patients was 50 years ± 20 years and patients. Respiratory infection, malignancy, pulmonary infiltrate in febrile neutropenia (FN), and hemoptysis in order of frequency were the main indications. The overall diagnostic yield was 46%. Mycobacterium tuberculosis (MTB) was the most common indication (26.8%) and was identified in 37.7%, whereas pneumonia was confirmed in 46.3% of the patients. Malignancy was established in 35.3% of suspected cases, while eosinophilic pneumonia was diagnosed in 100%. The diagnostic yield in pulmonary infiltrates of human immunodeficiency viral (HIV) was 85.7%. Alveolar hemorrhage was the most common cause of hemoptysis. Out of therapeutic bronchoscopy, lung collapse was the main indication. There is no mortality and complications occurred in 1.5% of the cases. Conclusion MTB was the most common indication of FFB, followed by malignancy. It has a high diagnostic yield in eosinophilic pneumonia and pulmonary infiltrates in HIV patients. FFB is shown to be a safe modality for diagnostic and therapeutic purposes.

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Section: Discussionmentioning

confidence: 99%

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

Qanash¹,

Hakami²,

Al-Husayni³

et al. 2020

Cureus

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“…Although different opinions have been expressed regarding the importance of the source and type of test sample ( Bunyasi et al, 2015 ), the quality of the specimen has been considered as a determinant factor affecting assay performance ( Pinto and Udwadia, 2013 ). Theron et al (2014) found that expectorated sputum was the best specimen with the highest sensitivity among all pulmonary specimens including BALF, possibly due to the highest bacterial load of the sputum that has been expectorated properly ( Iyer et al, 2011 ; Theron et al, 2014 ). However, unacceptable quality of sputum samples received by diagnostic laboratories is a common issue in China and worldwide and has become a significant cause of low diagnostic yield ( Heineman et al, 1977 ; Macq et al, 2005 ; Ou et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

“…We suspected that the current inadequacies in sputum collection in the two hospitals that participated in this study might have led to insufficient quality of expectorated sputum used for testing and consequentially may have affected the performance of all diagnostic assays. In the two hospitals, bronchoscopy and BALF are routinely recommended for patients who are sputum-scarce or have negative sputum smear-microscopy and Xpert MTB/RIF, while their clinical and radiological examinations are highly suggestive of pulmonary TB, or for differential diagnosis to clarify the underlying cause of a radiographic abnormality ( de Gracia et al, 1988 ; Iyer et al, 2011 ). When a head-to-head comparison was carried out between BALF and expectorated sputum obtained from the same patients at the same time point to avoid sampling bias, BALF was found to be superior to expectorated sputum in diagnosing pulmonary TB in the population sampled.…”

Section: Discussionmentioning

confidence: 99%

“…Sputum, either spontaneously expectorated or induced, has been often linked to a low diagnostic yield for detecting M. tuberculosis , due to insufficient sample quantity and/or quality ( Sakundarno et al, 2009 ; Hepple et al, 2012 ; Meyer et al, 2017 ). Although bronchoscopy is considered to be an invasive and costly technique that requires specific training of the infectious disease physician, it has been recommended for patients with suspected pulmonary TB in regions with a high frequency of TB ( Iyer et al, 2011 ), or at least for those who failed to spontaneously produce sputum ( Lee et al, 2013 ). Recent studies have found that when combined with Xpert MTB/RIF, BALF could provide accurate results in detecting early-stage pulmonary TB, in particular in smear-negative patients ( Theron et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Evaluation of Xpert MTB/RIF Assay With Bronchoalveolar Lavage Fluid as a Single Test or Combined With Conventional Assays for Diagnosis of Pulmonary Tuberculosis in China: A Two-Center Prospective Study

et al. 2018

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Introduction: The Xpert MTB/RIF is recommended by the World Health Organization as a first line rapid test for the diagnosis of pulmonary tuberculosis (TB); however, China does not routinely use this test, partially due to the lack of a sufficient number of systematic evaluations of this assay in local patients. The aims of this study were to comprehensively assess the diagnostic performance of Xpert MTB/RIF, either alone or in combination with conventional assays for the diagnosis of pulmonary TB in adult Chinese patients.Methods: Xpert MTB/RIF tests were performed in 190 adult patients with suspected pulmonary TB, using bronchoalveolar lavage fluid (BALF) as test specimens. In parallel, conventional tests were carried out using the same BALF samples. Using two different reference standards, the performance of Xpert MTB/RIF, conventional assays and their combinations were evaluated.Results: Using mycobacterial culture as the reference comparator, Xpert MTB/RIF was found to be superior to smear-microscopy in detecting Mycobacterium tuberculosis. When final diagnosis, based on clinical criteria, was employed as the reference standard, Xpert MTB/RIF showed an even higher accuracy of 72.1%, supported by a sensitivity of 61.1% and specificity of 96.6%. Xpert MTB/RIF also demonstrated a powerful capability to identify pulmonary TB cases undetected by culture or smear-microscopy. Combining smear-microscopy and Xpert MTB/RIF was found to be the most accurate early predictor for pulmonary TB. Rifampicin resistance reported by Xpert MTB/RIF slightly deviated from that by phenotypic antibiotic susceptibility testing and requires further study with a larger sample size.Conclusion: This two-center prospective study highlights the value of Xpert MTB/RIF with BALF in diagnosing pulmonary TB in adult Chinese patients. These findings might contribute to the optimization of current diagnostic algorithms for pulmonary TB in China.

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“…Although, only five of 24 patients (20.8%) who failed early diagnosis with IS underwent bronchoscopy in this study, the addition of bronchoscopy enabled early diagnosis of PTB in 60% (3 of 5) and increased bacteriologically confirmed diagnosis rate in 20% (1 of 5) ( Table 2 ). Iyer et al 26 also showed that bronchoscopy provided diagnostic confirmation of PTB in 10% of patients suspected with PTB with negative IS smear and TB-PCR results. Thus, bronchoscopy may be useful for a rapid and accurate diagnosis of PTB when IS smear and TB-PCR are negative.…”

Section: Discussionmentioning

confidence: 98%

Efficacy of Induced Sputum for the Diagnosis of Pulmonary Tuberculosis in Adults Unable to Expectorate Sputum

Park

2015

Tuberc Respir Dis

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BackgroundInduced sputum (IS) has been used to collect airway secretions in subjects who have inadequate sputum production. The aim of this study was to investigate the efficacy of IS for the diagnosis of pulmonary tuberculosis (PTB) in adults unable to expectorate sputum.MethodsMedical records of 39 PTB patients who underwent IS due to absence of spontaneous sputum production between January 2011 and March 2014 at a tertiary hospital in South Korea were reviewed. Results of acid fast bacilli smear, Mycobacterium tuberculosis culture and polymerase chain reaction assay for M. tuberculosis (TB-PCR) of IS specimens from these patients were analyzed. Clinical and high-resolution computed tomography (HRCT) characteristics were also analyzed to find characteristics associated with IS culture positivity.ResultsOf the 39 IS specimens from PTB patients, 7 (17.9%) were smear positive and 31 (79.5%) were culture positive. Twenty-four IS specimens were tested for TB-PCR and 13 (54.2%) were positive on TB-PCR. Multivariate analysis showed that younger age (p=0.04) and presence of tree-in-bud appearance on HRCT (p=0.03) were independent predictors of IS culture positivity.ConclusionIS is useful for the diagnosis of PTB in adults unable to expectorate sputum. Younger age and tree-in-bud appearance on HRCT were associated with IS culture positivity in these patients.

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Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD® Gen-probe testing

Abstract: Bronchoscopy provided diagnostic confirmation of pulmonary TB in 10% of subjects at least 2 negative induced-sputum samples by smear microscopy and NAA testing.

Cited by 23 publications

References 38 publications

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

A Comprehensive Evaluation of Xpert MTB/RIF Assay With Bronchoalveolar Lavage Fluid as a Single Test or Combined With Conventional Assays for Diagnosis of Pulmonary Tuberculosis in China: A Two-Center Prospective Study

Efficacy of Induced Sputum for the Diagnosis of Pulmonary Tuberculosis in Adults Unable to Expectorate Sputum

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