Post-bronchoscopy sputum: Improving the diagnostic yield in smear negative pulmonary TB

Peter M. George, Meera Mehta, Jaideep Dhariwal, Aran Singanayagam, Claire E. Raphael, Mohammad Salmasi, David W Connell, Philip Molyneaux, Melissa Wickremasinghe, Annette Jepson, Onn Min Kon

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    Abstract

    INTRODUCTION: Patients with suspected active Pulmonary Tuberculosis (PTB) who are Acid-Fast Bacilli (AFB) smear negative or non-productive of sputum may undergo bronchoalveolar lavage. However, post-bronchoscopy sputum (PBS) sampling is not routine. The aim of this study was to establish the potential diagnostic value of PBS sampling.

    METHODS: A retrospective study of patients attending a London University hospital with microbiologically confirmed PTB between January 2004 and December 2010. Patients who were AFB smear negative or non-productive of sputum were eligible if sputum sampling was performed within 7 days of bronchoscopy.

    RESULTS: Over the study period, 236 patients had microbiologically confirmed smear negative PTB of which 57 patients were eligible for the study. 15 patients (26.3%) were infected with HIV. 19 patients (33.3%) converted to AFB sputum smear positivity post-bronchoscopy and 5 patients (8.8%) were exclusively AFB sputum smear positive on PBS microscopy. Mycobacterium tuberculosis was cultured from the PBS of 43 patients (75.4%) and of these, 4 (7.0%) were exclusively PBS culture positive.

    CONCLUSION: PBS analysis can provide a simple method of rapidly diagnosing pulmonary tuberculosis. In this cohort, M. tuberculosis culture yield was increased by 7% through PBS sampling. This study has important infection control implications with nearly one third of patients becoming more infectious after bronchoscopy.

    Original languageEnglish
    Pages (from-to)1726-1731
    Number of pages6
    JournalRespiratory Medicine
    Volume105
    Issue number11
    DOIs
    Publication statusPublished - Nov 2011

    Keywords

    • Adolescent
    • Adult
    • Aged
    • Aged, 80 and over
    • Bronchoalveolar Lavage Fluid/microbiology
    • Bronchoscopy
    • Female
    • Humans
    • London/epidemiology
    • Male
    • Middle Aged
    • Mycobacterium tuberculosis/isolation & purification
    • Retrospective Studies
    • Sensitivity and Specificity
    • Sputum/microbiology
    • Tuberculosis, Pulmonary/diagnosis
    • Young Adult

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  • Cite this

    George, P. M., Mehta, M., Dhariwal, J., Singanayagam, A., Raphael, C. E., Salmasi, M., Connell, D. W., Molyneaux, P., Wickremasinghe, M., Jepson, A., & Kon, O. M. (2011). Post-bronchoscopy sputum: Improving the diagnostic yield in smear negative pulmonary TB. Respiratory Medicine, 105(11), 1726-1731. https://doi.org/10.1016/j.rmed.2011.07.014