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

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.

scholarly journals Utility of Bronchoalveolar Lavage in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

2020 ◽  
Vol 8 (1) ◽  
pp. 19-22
Author(s):  
Subodh Sagar Dhakal ◽  
Ashmita Neupane ◽  
Shatdal Chaudhary ◽  
Navin Mishra ◽  
Damber Bdr Karki
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Diagnostic Yield ◽  
Cross Sectional Study ◽  
Fibreoptic Bronchoscopy ◽  
Sputum Smear ◽  
Cross Sectional ◽  
Acid Fast Bacilli ◽  
Smear Negative

INTRODUCTION: Sputum smear examination for acid fast bacilli (AFB) by Ziehl-Neelsen stain (ZN stain) is the initial approach to the diagnosis of pulmonary tuberculosis (PTB). But 50% of the cases are reported to be sputum smear negative. This study was aimed to investigate the diagnostic yield of fibreoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. The sample was tested for Mycobacterium tuberculosis using the XpertMTB/RIF assay, which is a new test that detects Mycobacterium tuberculosis complex and resistance to rifampin in less than two hours. MATERIAL AND METHODS: This is a prospective cross sectional study carried out on 58 sputum smear negative patients who were clinically suspected to have pulmonary tuberculosis from April 2017 to January 2019. All patients are subjected to FOB, BAL and BAL specimens were stained for AFB and also sent for Xpert (MTB)/RIF. RESULTS: Among 58 patients enrolled for the study 26 patients were positive for acid fast bacilli (AFB) through BAL stain and Xpert (MTB)/RIF combined. CONCLUSION: FOB guided BAL is a reliable, alternative and rapid method for diagnosing smear negative pulmonary tuberculosis with minimal complications.

scholarly journals Diagnostic Accuracy of Ziehl-Neelsen Smear Microscopy in Comparison with GeneXpert in Pulmonary Tuberculosis: A Multi-Center Study in Kandahar Province, Afghanistan

2021 ◽  
pp. 1-7
Author(s):  
Mujeeb Ahmad ◽  
Muhammad Haroon Stanikzai ◽  
Najeeb Rahimy ◽  
Abdul Wahed Wasiq ◽  
Hadia Sayam
Keyword(s):  
Pulmonary Tuberculosis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Disease Transmission ◽  
Predictive Value ◽  
Smear Microscopy ◽  
Cross Sectional ◽  
Pulmonary Tb ◽  
Kappa Value

Background: Tuberculosis (TB) is a major global health problem. The early and accurate diagnosis is crucial for disease management and to control disease transmission and the emergence of drug resistance TB. Objectives: This study was carried out to determine the diagnostic accuracy of Ziehl Neelsen (ZN) smear microscopy in comparison with GeneXpert MTB/RIF in pulmonary tuberculosis in Kandahar province, Afghanistan. Methods: This was a facility-based cross-sectional study. We scrutinized TB registers of three health facilities to include patients who had their sputum tested by both ZN smear microscopy and GeneXpert MTB/RIF. We extracted 734 patients’ data registered during January 2019 - June 2020 in a structured form. Kappa value was analyzed using SPSS version 19 software at 95% Confidence Interval (CI). We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of ZN smear microscopy against GeneXpert MTB/RIF. Results: In comparison with GeneXpert as a reference test, ZN smear microscopy has 67.7% (95% CI:63.44%-70.74%) sensitivity and 100% (95% CI:98.74%-100.00%) specificity. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 99.89% (95% CI:99.88%-99.90%), respectively. The agreement between ZN smear microscopy and GeneXpert MTB/RIF results was moderate (70.4%) and the Kappa value was 0.45 (95% CI:0.38-0.59). Conclusion: This study has found high specificity but moderate sensitivity for the diagnosis of pulmonary TB using sputum ZN smear microscopy test. Hence, GeneXpert MTB/RIF test is more accurate and reliable for the diagnosis of pulmonary TB.

scholarly journals Diagnostic Accuracy of Xpert MTB/RIF in Sputum Smear-Negative Pulmonary Tuberculosis

Cureus ◽  
2019 ◽  
Author(s):  
Waqas Rasheed ◽  
Nisar Ahmed Rao ◽  
Hatem Adel ◽  
Mirza Saifullah Baig ◽  
Syed Omair Adil
Keyword(s):  
Pulmonary Tuberculosis ◽  
Diagnostic Accuracy ◽  
Sputum Smear ◽  
Smear Negative

scholarly journals Role of fiberoptic bronchoscopy in sputum smear negative suspected cases of pulmonary tuberculosis: a study conducted in Southern part of Rajasthan

2020 ◽  
Vol 8 (12) ◽  
pp. 4302
Author(s):  
Atul Luhadia ◽  
Shanti K. Luhadia ◽  
Shubham Jain ◽  
Mohammad Hamza Hanfe ◽  
Divax Oza ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Diagnostic Yield ◽  
Radiological Finding ◽  
Fiberoptic Bronchoscopy ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
Acid Fast Bacilli ◽  
Predominant Symptom ◽  
Smear Negative

Background: Sputum smear negative pulmonary tuberculosis is a common problem faced by clinicians. Fiberoptic bronchoscopy may be very useful in diagnosing these cases which have no sputum or whose sputum smear is negative for acid fast bacilli. Objective of the current study was to assess the role of fiberoptic bronchoscopy in sputum smear negative under NTEP and radiologically suspected cases of pulmonary tuberculosis.Methods: Clinico-radiological suspected cases of pulmonary tuberculosis patients in whom two sputum smear for acid fast bacilli by Ziehl Neelsen stain under NTEP was negative were included in the study. Fiberoptic bronchoscopy was performed in all these patients and samples taken were sent for investigations.Results: Fiberoptic bronchoscopy was performed in 250 patients of suspected pulmonary tuberculosis whose sputum for AFB smear was negative. Cough was the most predominant symptom. Radiologically, right side disease was more common and upper zone was most commonly involved and infiltrates were common radiological finding. During bronchoscopy, congestion and hyperaemia (36%) and mucopurulent/mucoid secretions (32%) was seen in maximum number of cases. BAL was positive in 200 patients (80%), post bronchoscopy sputum was positive in 70 cases (28%) and biopsy was positive in 12 patients out of 16 performed biopsies (75%). The total TB positive cases after combining all the methods were 215 making the overall diagnostic yield of 86%.Conclusions: Fiberoptic bronchoscopy and post bronchoscopy sputum can be very useful for diagnosing sputum for AFB smear negative but clinico-radiological suspected cases of pulmonary tuberculosis patients.

scholarly journals Diagnostic challenges and Gene-Xpert utility in detecting Mycobacterium tuberculosis among suspected cases of Pulmonary tuberculosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251858
Author(s):  
Shaila Kabir ◽  
M. Tanveer Hossain Parash ◽  
Nor Amalina Emran ◽  
A. B. M. Tofazzal Hossain ◽  
Sadia Choudhury Shimmi
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Predictive Value ◽  
Demographic Data ◽  
Nucleic Acid Amplification ◽  
Age Group ◽  
Cross Sectional ◽  
Care Clinic ◽  
Pulmonary Tb ◽  
Smear Negative

The incidence of pulmonary tuberculosis (PTB) can be reduced by preventing transmission with rapid and precise case detection and early treatment. The Gene-Xpert MTB/RIF assay is a useful tool for detecting Mycobacterium tuberculosis (MTB) with rifampicin resistance within approximately two hours by using a nucleic acid amplification technique. This study was designed to reduce the underdiagnosis of smear-negative pulmonary TB and to assess the clinical and radiological characteristics of PTB patients. This cross-sectional study included 235 participants who went to the Luyang primary health care clinic from September 2016 to June 2017. The demographic data were analyzed to investigate the association of patient gender, age group, and ethnicity by chi-square test. To assess the efficacy of the diagnostic test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The area under the curve for sputum for both AFB and gene-Xpert was analyzed to compare their accuracy in diagnosing TB. In this study, TB was more common in males than in females. The majority (50.71%) of the cases belonged to the 25–44-year-old age group and the Bajau ethnicity (57.74%). Out of 50 pulmonary TB cases (smear-positive with AFB staining), 49 samples were positive according to the Gene-Xpert MTB/RIF assay and was confirmed by MTB culture. However, out of 185 smear-negative presumptive cases, 21 cases were positive by Gene-Xpert MTB/RIF assay in that a sample showed drug resistance, and these results were confirmed by MTB culture, showing resistance to isoniazid. In comparison to sputum for AFB, Gene-Xpert showed more sensitivity and specificity with almost complete accuracy. The additional 21 PTB cases detection from the presumptive cases by GeneXpert had significant impact compared to initial observation by the routine tests which overcame the diagnostic challenges and ambiguities.

Sign in / Sign up

Export Citation Format

Share Document