The Role of Fiberoptic Bronchoscopy for Diagnosis of Pulmonary Tuberculosis in Patients at Risk for AIDS

Miro, A. M.; Gibilara, E.; Powell, Steven; Kamholz, Stephan L.

doi:10.1378/chest.101.5.1211

Cited by 36 publications

(12 citation statements)

References 10 publications

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“…Miro et al, (6) in a retrospective evaluation of respiratory secretion samples collected by bronchoscopy for detection of M. tuberculosis in HIV-positive patients, observed that adding the TBB findings increased the diagnostic yield from 96% to 100%. A similar result was observed in HIV-negative patients.…”

Section: Discussionmentioning

confidence: 99%

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

et al. 2012

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Objective: To evaluate the diagnostic accuracy of bronchoscopy in patients with clinical or radiological suspicion of tuberculosis who were unable to produce sputum or with negative sputum smear microscopy results. Methods: A prospective cross-sectional study involving 286 patients under clinical or radiological suspicion of having pulmonary tuberculosis and submitted to bronchoscopy-BAL and transbronchial biopsy (TBB). The BAL specimens were submitted to direct testing and culture for AFB and fungi, whereas the TBB specimens were submitted to histopathological examination. Results: Of the 286 patients studied, 225 (79%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 127 (44%); nonspecific chronic inflammation, in 51 (18%); pneumocystis, fungal infections, or nocardiosis, in 20 (7%); bronchiolitis obliterans organizing pneumonia, alveolites, or pneumoconiosis, in 14 (5%); lung or metastatic neoplasms, in 7 (2%); and nontuberculous mycobacterium infections, in 6 (2%). For the diagnosis of tuberculosis, BAL showed a sensitivity and a specificity of 60% and 100%, respectively. Adding the TBB findings significantly increased this sensitivity (to 84%), as did adding the post-bronchoscopy sputum smear microscopy results (total sensitivity, 94%). Minor post-procedure complications occurred in 5.6% of the cases. Conclusions: Bronchoscopy is a reliable method for the diagnosis of pulmonary tuberculosis, with low complication rates. The combination of TBB and BAL increases the sensitivity of the method and facilitates the differential diagnosis with other diseases.Keywords: Bronchoscopy; Tuberculosis, pulmonary; Sputum; Bronchoalveolar lavage; Biopsy. ResumoObjetivo: Avaliar a acurácia diagnóstica da broncoscopia em pacientes com suspeita clínica ou radiológica de tuberculose, com baciloscopia negativa ou incapazes de produzir escarro. Métodos: Estudo transversal prospectivo de 286 pacientes com suspeita clínica/radiológica de tuberculose pulmonar e submetidos à broncoscopia -LBA e biópsia transbrônquica (BTB). As amostras de LBA foram testadas por pesquisas diretas e culturas de BAAR e de fungos, e as de BTB por exame histopatológico. Resultados: Dos 286 pacientes estudados, a broncoscopia contribuiu para o diagnóstico em 225 (79%): tuberculose pulmonar em 127 (44%); inflamações crônicas inespecíficas em 51 (18%); pneumocistose, infecções fúngicas ou nocardiose em 20 (7%); bronquiolite obliterante com pneumonia em organização, alveolites ou pneumoconioses em 14 (5%); neoplasias pulmonares ou metastáticas em 7 (2%); e micobacterioses não tuberculosas em 6 (2%). Para o diagnóstico de tuberculose, o LBA mostrou sensibilidade e especificidade de 60% e 100% respectivamente, havendo um aumento importante da sensibilidade quando associado à biópsia (84%) e à baciloscopia após a broncoscopia (94%). Complicações controláveis decorrentes do procedimento ocorreram em 5,6% dos casos. Conclusões: A broncoscopia representa um método diagnóstico confiável para pacientes com tubercu...

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Section: Discussionmentioning

confidence: 99%

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

et al. 2012

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“…[74][75][76][77] Miro et al studied a group of 27 high risk patients for HIV infection (only 18 of 27 had clinical confirmation of HIV infection). 78 The diagnostic yield of positive AFB smears from sputum, BAL, and bronchial washings was 30% compared to 37% from bronchial brushings and transbronchial biopsies (p = NS). The addition of the transbronchial biopsy specimen increased the culture yield from 96% to 100% (p = NS).…”

Section: Diagnosismentioning

confidence: 88%

Tuberculosis and HIV Infection

Garay¹

1995

Semin Respir Crit Care Med

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“…[6] Previous reports in non-immunocompromised patients with sputum smear-negative TB indicated that bronchoscope specimens and post bronchoscope sputum are helpful in establishing the diagnosis. [78] As per Adelaithi M et al .,[9] diagnostic FOB is often performed before the final results of the sputum analysis are available, to exclude other common infections, such as Pneumocystis carinii pneumonia, to confirm PT. Hence, the present study adumbrated a similar picture helping the clinician to treat the cases immediately not withstanding the radiological shadows.…”

Section: Discussionmentioning

confidence: 99%

A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oro pharyngeal spacer

Chandra

Dash

Srinivas

et al. 2012

J Fam Community Med

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Introduction:The tuberculosis control program is based on a felt need–oriented basis. The diagnosis is mainly microbiological. However, sputum smear-negative Acid Fast Bacilli (AFB) cases with suspected radiological findings can be problematic in diagnosis.Objectives:To confirm the diagnosis of tuberculosis early, in smear-negative AFB cases by using a Fiberoptic Bronchoscope.Materials and Methods:We embarked on Fiberoptic Bronchoscopy (FOB) and Spot Scopy smear Microscopy (SSM) for 533 suspected Pulmonary Tuberculosis (PT) cases (sputum smear negative and radiologically suggestive) from February 2007 to May 2010. FOB was performed using a special device, a Trans Oro Pharyngeal Spacer (TOPS), as a conduit.Results:The yield for positivity for AFB was 341 (64%) out of 533 cases.Conclusion and Recommendation:The specimens collected by using the fiberoptic bronchoscope confirmed the disease in the smear-negative cases. Hence, FOB was recommended in smear-negative cases, to avoid delay in the treatment of tuberculosis.

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The Role of Fiberoptic Bronchoscopy for Diagnosis of Pulmonary Tuberculosis in Patients at Risk for AIDS

Cited by 36 publications

References 10 publications

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

Tuberculosis and HIV Infection

A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oro pharyngeal spacer

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