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

doi:10.1016/j.rmed.2011.07.014

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

Research output: Contribution to journal › Article › peer-review

20 Citations (Scopus)

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 language	English
Pages (from-to)	1726-1731
Number of pages	6
Journal	Respiratory Medicine
Volume	105
Issue number	11
DOIs	https://doi.org/10.1016/j.rmed.2011.07.014
Publication status	Published - 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.rmed.2011.07.014

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title = "Post-bronchoscopy sputum: Improving the diagnostic yield in smear negative pulmonary TB",

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.",

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",

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

year = "2011",

month = nov,

doi = "10.1016/j.rmed.2011.07.014",

language = "English",

volume = "105",

pages = "1726--1731",

journal = "Respiratory Medicine",

issn = "0954-6111",

publisher = "W.B. Saunders Ltd",

number = "11",

}

TY - JOUR

T1 - Post-bronchoscopy sputum

T2 - Improving the diagnostic yield in smear negative pulmonary TB

AU - George, Peter M.

AU - Mehta, Meera

AU - Dhariwal, Jaideep

AU - Singanayagam, Aran

AU - Raphael, Claire E.

AU - Salmasi, Mohammad

AU - Connell, David W

AU - Molyneaux, Philip

AU - Wickremasinghe, Melissa

AU - Jepson, Annette

AU - Kon, Onn Min

PY - 2011/11

Y1 - 2011/11

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bronchoalveolar Lavage Fluid/microbiology

KW - Bronchoscopy

KW - Female

KW - Humans

KW - London/epidemiology

KW - Male

KW - Middle Aged

KW - Mycobacterium tuberculosis/isolation & purification

KW - Retrospective Studies

KW - Sensitivity and Specificity

KW - Sputum/microbiology

KW - Tuberculosis, Pulmonary/diagnosis

KW - Young Adult

U2 - 10.1016/j.rmed.2011.07.014

DO - 10.1016/j.rmed.2011.07.014

M3 - Article

C2 - 21840695

SN - 0954-6111

VL - 105

SP - 1726

EP - 1731

JO - Respiratory Medicine

JF - Respiratory Medicine

IS - 11

ER -

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

Abstract

Keywords

UN SDGs

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