Abstract
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.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References1. World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing: WHO Report 2007. Geneva, Switzerland, World Health Organization, (WHO/HTM/TB/2007.376).2. Dickson SJ, Brent A, Davidson RN, et al. Comparison of bronchoscopy and gastric washings in the investigation of smear-negative pulmonary tuberculosis. Clin Infect Dis 2003;37:1649–1653.DicksonSJ]]BrentA]]DavidsonRN&etal;Comparison of bronchoscopy and gastric washings in the investigation of smear-negative pulmonary tuberculosis.Clin Infect Dis2003371649-16533. Okutan O, Kartaloglu Z, Kilic E, et al. Diagnostic contribution of gastric and bronchial lavage examinations in cases suggestive of pulmonary tuberculosis. Yonsei Med J 2003;44:242–248.OkutanO]]KartalogluZ]]KilicE&etal;Diagnostic contribution of gastric and bronchial lavage examinations in cases suggestive of pulmonary tuberculosis.Yonsei Med J200344242-2484. Abadco DL, Steiner P. Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis. Pediatr Infect Dis J 1992;11:735–738.AbadcoDL]]SteinerPGastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis.Pediatr Infect Dis J199211735-7385. Venkateshiah SB, Mehta AC. Role of flexible bronchoscopy in the diagnosis of pulmonary tuberculosis in immunocompetent individuals. J Bronchol 2003;10:300–308.VenkateshiahSB]]MehtaACRole of flexible bronchoscopy in the diagnosis of pulmonary tuberculosis in immunocompetent individuals.J Bronchol200310300-3086. Seaton A, Seaton D, Leitch AG. Crofton & Douglas’s Respiratory Diseases. Oxford, Blackwell Scientific Publications, 2000, ed 5, pp 518.7. Rizvi N, Rao NA, Hussain M. Yield of gastric lavage and bronchial wash in pulmonary tuberculosis. Int J Tuberc Lung Dis 2000;4:147–151.RizviN]]RaoNA]]HussainMYield of gastric lavage and bronchial wash in pulmonary tuberculosis.Int J Tuberc Lung Dis20004147-1518. Tahaoğlu K, Kizkin O, Karagöz T, et al. High initial and acquired drug resistance in pulmonary tuberculosis in Turkey. Tuber Lung Dis 1994;75:324–328.TahaoğluK]]KizkinO]]KaragözT&etal;High initial and acquired drug resistance in pulmonary tuberculosis in Turkey.Tuber Lung Dis199475324-3289. Chan HS, Sun AJ, Hoheisel GB. Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis. Lung 1990;168:215–220.ChanHS]]SunAJ]]HoheiselGBBronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis.Lung1990168215-22010. Danek SJ, Bower JS. Diagnosis of pulmonary tuberculosis by flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1979;119:677–679.DanekSJ]]BowerJSDiagnosis of pulmonary tuberculosis by flexible fiberoptic bronchoscopy.Am Rev Respir Dis1979119677-67911. Jett JR, Cortese DA, Dines DE. The value of bronchoscopy in the diagnosis of mycobacterial disease. A five-year experience. Chest 1981;80:575–578.JettJR]]CorteseDA]]DinesDEThe value of bronchoscopy in the diagnosis of mycobacterial disease. A five-year experience.Chest198180575-57812. Wallace JM, Deutsch AL, Harrell JH, et al. Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis. Am J Med 1981;70:1189–1194.WallaceJM]]DeutschAL]]HarrellJH&etal;Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis.Am J Med1981701189-119413. Saglam L, Akgun M, Aktas E. Usefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis. J Int Med Res 2005;33:260–265.SaglamL]]AkgunM]]AktasEUsefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis.J Int Med Res200533260-26514. Schoch OD, Rieder P, Tueller C, et al. Diagnostic yield of sputum, induced sputum, and bronchoscopy after radiologic tuberculosis screening. Am J Respir Crit Care Med 2007;175:80–86.SchochOD]]RiederP]]TuellerC&etal;Diagnostic yield of sputum, induced sputum, and bronchoscopy after radiologic tuberculosis screening.Am J Respir Crit Care Med200717580-8615. de Gracia J, Curull V, Vidal R, et al. Bronchoscopy with bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis. Chest 1992;101:292.de GraciaJ]]CurullV]]VidalR&etal;Bronchoscopy with bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis.Chest199210129216. Brown M, Varia H, Bassett P, et al. Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate. Clin Infect Dis 2007;44:1415–1420.BrownM]]VariaH]]BassettP&etal;Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate.Clin Infect Dis2007441415-142017. Somu N, Swaminathan S, Paramasivan CN, et al. Value of bronchoalveolar lavage and gastric lavage in the diagnosis of pulmonary tuberculosis in children. Tuber Lung Dis 1995;76:295–299.SomuN]]SwaminathanS]]ParamasivanCN&etal;Value of bronchoalveolar lavage and gastric lavage in the diagnosis of pulmonary tuberculosis in children.Tuber Lung Dis199576295-299
