Bronchoscopy and Tuberculostearic Acid Assay in the Diagnosis of Sputum Smear-negative Pulmonary Tuberculosis: A Prospective Study with the Addition of Transbronchial Biopsy

Background: Tuberculosis is a major global public health problem. It is caused by mycobacterium tuberculosis and it is a leading cause of death in developing countries like India. WHO recommends the detection of acid fast bacilli in sputum as the initial diagnosis of pulmonary TB. Tuberculosis is spread from person to person through air by droplet nuclei. So, early detection and prompt treatment of tuberculosis is main cornerstone to prevent transmission into community. Bronchial washing is very helpful for early detection of mycobacterium tuberculosis.Methods: This is a prospective study of 53 sputum smear negative patients underwent for bronchoscopy. After a detailed medical history and physical examination, Patients with a negative sputum smear AFB examination and a strong clinco-radiological suspicion of pulmonary tuberculosis were then counseled, consented and subjected to fiber-optic bronchoscopy with bronchial washings and bronchial biopsy in case of endobronchial lesions.Results: Our study showed mean age of patient is about 43.49 year and has predominantly male patients. Most cardinal symptoms were fever (83%) and cough (74%). Most radiological findings were consolidation and cavity lesion accordingly. Sputum culture was positive in 14 (26%) patients out of 53 patients and bronchial washing smear positive for AFB in 30 (57%) patients and bronchial washing culture positive for AFB in 40 (75%) patients out of 53 patients.Conclusions: Bronchial washings analysis for detection of AFB is much more reliable in comparison to direct smear microscopy and direct sputum culture examination.

Download Full-text

Diagnosing sputum smear negative pulmonary tuberculosis patients by transbronchial biopsy and bronchoalveolar lavage smear.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3279 ◽

2020 ◽

Vol 27 (03) ◽

pp. 499-505

Author(s):

Mahwish Niaz ◽

Mumtaz Ahmad ◽

Kanwal Fatima ◽

Faiza Kazi ◽

Hassan Salim ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Diagnostic Accuracy ◽

Bronchoalveolar Lavage ◽

Disease Transmission ◽

Predictive Value ◽

Transbronchial Biopsy ◽

Sputum Smear ◽

Cross Sectional ◽

Tuberculosis Patients ◽

Smear Negative

Pulmonary tuberculosis is one of the leading causes of infectious disease related mortality. Transbonchial biopsy and bronchoalveolar lavage smear obtained by bronchoscopy provides greater quantity of material for analysis, thus increases the chances of diagnosing the disease. Objectives: To diagnose sputum smear negative pulmonary tuberculosis patients by Transbronchial Biopsy and Bronchoalveolar smear keeping bronchoalvelar lavage culture as gold standard. To calculate and compare the diagnostic accuracy of transbronchial biopsy and bronchoalveolar lavage smear in sputum negative patients. Study Design: Cross-sectional validation study. Setting: Department of histopathology, Foundation University Medical College, Islamabad and Department of Pulmonology and Microbiology, Fauji Foundation Hospital, Rawalpindi. Period: From May 2016 to May 2017. Materials & Methods: It comprised 96 patients who underwent bronchoscopy. Transbronchial biopsy, bronchoalveolar lavage smear preparation and bronchoalveolar lavage culture was performed on specimens of all patients. Results: Out of 96 patients 22 (22.91%) patients were actually having tuberculosis whereas 74 (77%) had only clinical and radiological suspicion of tuberculosis. The mean age of patients was 43 years with a standard deviation of ±19.1 .The age range was 12-80 years. The sensitivity, specificity, positive predictive value, negative predictive value and true positives of transbronchial biopsy were 68.1%, 77%, 46.8%, 89% and15.62% while the values for bronchoalveolar lavage were 50%, 97.29%, 84.6%, 86.7% and 11.45% respectively. Thus, the diagnostic accuracy calculated for transbronchial biopsy and bronchoalveolar lavage was 75% and 13.54% respectively. Conclusions: Bronchoscopy should be done in all sputum negative tuberculosis patients having strong clinical and radiological suspicion to obtain transbronchial biopsy and bronchoalveolar lavage for timely diagnosis, treatment and prevention of disease transmission as well as to avoid empirical treatment and its side effects in patients having no tuberculosis. The diagnostic accuracy of transbronchial biopsy is almost 5 times more compared to bronchoalveolar lavage smear.

Download Full-text

Treatment adherence among sputum smear-positive pulmonary tuberculosis patients in Xinjiang, China: a prospective study

RSC Advances ◽

10.1039/c7ra11820a ◽

2018 ◽

Vol 8 (16) ◽

pp. 8983-8989

Author(s):

Xinji Gong ◽

Yuehua Li ◽

Jing Wang ◽

Gang Wu ◽

Ayinuer Mohemaiti ◽

...

Keyword(s):

Drug Resistance ◽

Drug Therapy ◽

Pulmonary Tuberculosis ◽

Prospective Study ◽

Treatment Adherence ◽

Sputum Smear ◽

Great Effort ◽

Tuberculosis Patients ◽

Smear Positive Pulmonary Tuberculosis ◽

A Prospective Study

Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance.

Download Full-text

Urine lipoarabinomannan in HIV uninfected, smear negative, symptomatic TB patients: effective sample pretreatment for a sensitive immunoassay and mass spectrometry

Scientific Reports ◽

10.1038/s41598-021-82445-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anita G. Amin ◽

Prithwiraj De ◽

Barbara Graham ◽

Roger I. Calderon ◽

Molly F. Franke ◽

...

Keyword(s):

Limit Of Detection ◽

Sample Pretreatment ◽

Positive Association ◽

Proteinase K ◽

Clinical Samples ◽

Sputum Smear ◽

Smear Negative ◽

Tuberculostearic Acid ◽

Negative Sputum ◽

Adult Culture

AbstractOur study sought to determine whether urine lipoarabinomannan (LAM) could be validated in a sample cohort that consisted mainly of HIV uninfected individuals that presented with tuberculosis symptoms. We evaluated two tests developed in our laboratory, and used them on clinical samples from Lima, Peru where incidence of HIV is low. ELISA analysis was performed on 160 samples (from 140 adult culture-confirmed TB cases and 20 symptomatic TB-negative child controls) using 100 μL of urine after pretreatment with Proteinase K. Two different mouse monoclonal antibodies-CS35 and CHCS9-08 were used individually for capture of urine LAM. Among cases, optical density (OD450) values had a positive association with higher bacillary loads. The 20 controls had negative values (below the limit of detection). The assay correctly identified all samples (97–100% accuracy confidence interval). For an alternate validation of the ELISA results, we analyzed all 160 urine samples using an antibody independent chemoanalytical approach. Samples were called positive only when LAM surrogates—tuberculostearic acid (TBSA) and d-arabinose (d-ara)—were found to be present in similar amounts. All TB cases, including the 40 with a negative sputum smear had LAM in detectable quantities in urine. None of the controls had detectable amounts of LAM. Our study shows that urinary LAM detection is feasible in HIV uninfected, smear negative TB patients.

Download Full-text