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

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

N1 - Copyright © 2011 Elsevier Ltd. All rights reserved.

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 -