Mushtaq Ahmad1, Wanis H Ibrahim2, Sabir Al Sarafandi3, Khezar S Shahzada4, Shakeel Ahmed5, Irfan Ul Haq6, Tasleem Raza7, Mansoor Ali Hameed8, Merlin Thomas9, Hisham Ab Ib Swehli10, Hisham A Sattar11. 1. Department of Medicine, Hamad General Hospital, Weill-Cornell Medical College, Doha, Qatar. Electronic address: Mahmad5@hamad.qa. 2. Hamad General Hospital, Qatar University and Weill-Cornell Medical College, Doha, Qatar. Electronic address: wanisian@yahoo.com. 3. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: sf.alsarafandi@gmail.com. 4. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: KSyed1@hamad.qa. 5. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: SAhmed30@hamad.qa. 6. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: IHaq@hamad.qa. 7. Hamad General Hospital, Weill-Cornell Medical College, Doha, Qatar. Electronic address: tmohd1@hamad.qa. 8. Hamad General Hospital, Doha, Qatar. Electronic address: MHameed5@hamad.qa. 9. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: MThomas27@hamad.qa. 10. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: hswehli@hamad.qa. 11. Department of Medicine, Hamad General Hospital, Doha, Qatar. Electronic address: HASATTAR@hamad.qa.
Abstract
BACKGROUND: The diagnostic value of bronchoalveolar lavage in patients with negative sputum/smear for tuberculous bacilli has been well studied. However, its value in the subset of patients with both negative sputum/smear and culture is seldom reported. METHODS: A retrospective study of patients referred for diagnostic bronchoscopy for the suspicion of pulmonary tuberculosis during the period from April 1st, 2015 to March 30th, 2016, and who had negative sputum/smear and culture for tuberculous bacilli. RESULTS: One hundred and ninety patients fulfilled the inclusion criteria. Bronchoalveolar lavage detected further 61/190 (32.1%) pulmonary tuberculosis cases. Bronchoalveolar lavage mycobacterial culture and polymerase chain reaction (positive in 60/190 (31.6%) and 58/190 (30.5%) of patients respectively) provided the highest diagnostic yield, whereas direct smear provided the lowest yield. Bronchoalveolar lavage had a sensitivity of 89.7%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 94.6%, and a test accuracy of 96.3% in suspected pulmonary tuberculosis cases with negative sputum/smear and culture. Positive bronchoalveolar lavage yield for tuberculosis was significantly associated with a positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, radiological evidence of upper zone abnormality and patient's origin being from the Indian subcontinent. CONCLUSION: Bronchoalveolar lavage should be pursued as a useful diagnostic tool for suspected pulmonary tuberculosis cases when sputum/smear and culture are negative. Its value is higher in the subset of patients with positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, upper zone abnormality on radiograph or being from the Indian subcontinent.
BACKGROUND: The diagnostic value of bronchoalveolar lavage in patients with negative sputum/smear for tuberculous bacilli has been well studied. However, its value in the subset of patients with both negative sputum/smear and culture is seldom reported. METHODS: A retrospective study of patients referred for diagnostic bronchoscopy for the suspicion of pulmonary tuberculosis during the period from April 1st, 2015 to March 30th, 2016, and who had negative sputum/smear and culture for tuberculous bacilli. RESULTS: One hundred and ninety patients fulfilled the inclusion criteria. Bronchoalveolar lavage detected further 61/190 (32.1%) pulmonary tuberculosis cases. Bronchoalveolar lavage mycobacterial culture and polymerase chain reaction (positive in 60/190 (31.6%) and 58/190 (30.5%) of patients respectively) provided the highest diagnostic yield, whereas direct smear provided the lowest yield. Bronchoalveolar lavage had a sensitivity of 89.7%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 94.6%, and a test accuracy of 96.3% in suspected pulmonary tuberculosis cases with negative sputum/smear and culture. Positive bronchoalveolar lavage yield for tuberculosis was significantly associated with a positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, radiological evidence of upper zone abnormality and patient's origin being from the Indian subcontinent. CONCLUSION: Bronchoalveolar lavage should be pursued as a useful diagnostic tool for suspected pulmonary tuberculosis cases when sputum/smear and culture are negative. Its value is higher in the subset of patients with positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, upper zone abnormality on radiograph or being from the Indian subcontinent.
Authors: Maria Antonella Zingaropoli; Patrizia Pasculli; Marco Iannetta; Valentina Perri; Matteo Tartaglia; Sebastiano Giuseppe Crisafulli; Chiara Merluzzo; Viola Baione; Lorenzo Mazzochi; Ambra Taglietti; Flavia Pauri; Marco Frontoni; Marta Altieri; Aurelia Gaeta; Guido Antonelli; Antonella Conte; Claudio Maria Mastroianni; Maria Rosa Ciardi Journal: Mult Scler J Exp Transl Clin Date: 2022-01-04