Research and Reports in Pulmonology

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Editorial - Research and Reports in Pulmonology (2021) Volume 2, Issue 2

Diagnosing pulmonary tuberculosis with fibre-optic bronchoscopy and its significant role


The 1990 World Health Organization (WHO) report on the
Global Burden of Disease ranked tuberculosis as the seventh
most morbidity-causing disease in the world, and expected it to
continue in the same position up to 2020. Someone somewhere
contracts tuberculosis every four seconds and one of them
dies every 10 seconds. In 2006, about 1.4 million cases of
tuberculosis were registered for treatment in India; 28.7% of
them were new smear negative cases. The initial diagnostic
approach to suspected cases of pulmonary tuberculosis is to
demonstrate Mycobacterium tuberculosis in stained smears of
expectorated sputum. In most of the tuberculosis centers, even
after meticulous search, the bacteriological positive yield from
sputum is around 16 to 50% and large portion remain negative in
spite of clinical profile and radiological lesions being consistent
with diagnosis of pulmonary tuberculosis. Early diagnosis
of pulmonary tuberculosis prevents progression of disease,
morbidity, spread of disease and permanent damage by fibrosis.
Culture of sputum for acid fast bacilli (AFB) takes long time and
a reliable serological test is not yet available. In such a situation
bronchoscopy has been tried for rapid diagnosis of tuberculosis
in smear negative cases. Fibreoptic bronchoscopy with bronchial
washing analysis for AFB including culture for Mycobacterium
tuberculosis has significant role to establish the diagnosis when
extensive search for AFB in expectorated sputum has repeatedly
failed, when sputum expectoration is absent or sputum
induction has failed. The present study aims to assess the role
of fibreoptic bronchoscopy in the diagnosis of sputum/smearnegative
pulmonary tuberculosis. The present study, approved
by the institutional ethics committee, was conducted in the
Department of Pulmonary Medicine. Clinically suspected cases
of pulmonary tuberculosis, aged 16-75 years, with three sputum
smears negative for AFB and a chest radiograph suggestive
of pulmonary tuberculosis were included in the study after
obtaining an informed consent. Patients with bleeding diathesis,
history of myocardial infarction or arrhythmia, extra-pulmonary
tuberculosis, history of anti-tubercular treatment (ATT) for more
than one month, and those with severe dyspnoea were excluded
from the study. HIV-positive and non-cooperative patients were
also excluded. A detailed history, clinical examination, and
routine investigations were carried out on suspected cases of
tuberculosis. Three sputum samples (spot, morning and spot)
were tested for presence of AFB in the smear. In patients with
suspected smear negative pulmonary tuberculosis, a sputum
sample was sent for sputum culture (BACTEC) and the patients
were taken up for bronchoscopy. Prior to the procedure an
informed written consent was obtained from the patient. The
procedure was carried out electively with the patient nil orally
for four to six hours. Patients were pre-medicated 30-45 minutes
Author(s): Debra Griffin

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