Fiberbronchoscopy In Smear-Negative...

Fiberbronchoscopy In Smear-Negative Miliary Tuberculosis (*1)

Although the pattern of miliary tuberculosis has changed in the West, [12] it still remains a question at issue in India. Because the sputum is frequently negative for acid-fast bacilli (AFB), the diagnosis is delayed or steady missed, resulting in increased mortality. [3] It has been shown to be unsuspected before death in up to 70 to 100 percent of cases. [1] freshly the fiberbronchoscope has offered an of the first grade means to safely obtain lower respiratory tract secretions and lung tissue. single one large study [4] of its use in establishing a rapid diagnosis in smear negative miliary tuberculosis has for a like reason far been published. We report our experience of fiber-bronchoscopy forward 22 sputum smear-negative patients with miliary tuberculosis.

MATERIAL AND METHODS

Twenty-two patients suspected clinically and radiologically to have miliary tuberculosis, if it were not that whose sputum smear was negative for AFB in succession three occasions or who were unable to create sputum, were subjected to fiberbronchoscopy. A millet-seed appearance, with diffuse nodular opacities measuring les than 2 mm in diameter, was considered consistent with the radiologic suspicion of miliary tuberculosis. [1]

Transnasal fiberbronchoscopy was perfromed forward all patients using the Olympus BF-P 10 sweep after premedication with 0.6 mg of atropine sulfate given IM. Since lignocaine is known to inhibit mycobacterial expansion the total dose instilled was limited to 4 ml of 4 percent and 4 ml of 2 percent solutions. [5] Disposable brushes were used to make brush smears before taking bronchial aspirations and transbronchial lung biopsy specimens. At least four biopsy specimens were obtained in each patient from solely one lung, without radiographic screening. A biopsy come was regarded as positive when granulomas with central caseation were seen Brush and bronchial aspirate smears were stained with Ziehl-Neelsen stain. Bronchial aspirates were also cultur in succession Lowenstein-Jensen medium after concentration. Brushings and biopsy specimens were not cultured

The criteria for diagnosis of tuberculosis were: (1) brush or bronchial aspirate smear positive for AFB; (2) caseating granulomas in transbronchial lung biopsy specimens; and (3) bronchial aspirate positive from culture.

RESULTS

Fiberbronchoscopy specimens provided a definite diagnosis of tuberculosis in 16 (73 percent) of 22 patients. Figure 1 exhibit tos the relative yield of various specimens. A rapid diagnosis was established in mostly patients (14/16, or 88 percent) either from brush smears alone (3/14 or 21 percent) at bronchial aspirate smears alone (1/14 or 7 percent) or exclusively from histopathologic study of biopsy specimens (7/14 or 50 percent) the two brush smears and histopathology confirmed the diagnosis in three (21 percent) of 14 patients. Bronchial aspirate refinement was positive in three (14 percent) of 22 patients. It was the merely positive sample in two patients, while it was also positive in the patient whose aspirate smear was positive.

Six (27 percent) patients could not be diagnosed by dint of fiberbronchoscopy. Sputum culture accrues and liver biopsy confirmed the diagnosis in these patients.

Transbronchial lung biopsy conclusioned in moderate bleeding and self-limiting hemoptysis in the same patient, while two patients make knowned pneumothoraces that required no intervention.

DISCUSSION

The fiberbronchoscope was first used in 1975 to establish a diagnosis of tuberculosis in a patient with miliary mottling. [6] It confirmed the diagnosis in six of eight patients reviewed by dint of Burk et al. [7] sum of two units of these patients, however, were sputum smear positive. Willcox et al [8] first demonstrated the contribution of bronchial brushings to the overall yield of the action Brush smears were positive in seven o nine of their patients with miliary tuberculosis.

Willcox et al [4] reported the solitary large series of fiberbronchoscopy in smear-negative miliary tuberculosis. Fiberbronchoscopy helped in making a diagnosis of tuberculosis in 83 percent of their patients; a rapid diagnosis was achieved in 79 percent of these patients. Our originates have demonstrated a similar efficacy the two in early diagnosis and overall yield. Our transbronchial biopsy originates (positive in 63 percent patients) are comparable to those of Willcox et al, [4] calm though all biopsies were taken blindly, without radiologic screening. With an acceptable complication rate, it is clear that transbronchial lung biopsies can be attempted blindly without unfavorably affecting diagnostic yield or complication rate. Bronchial brushings alone provided the diagnosis in three of our patients. It is useful despite a gentle yield, as it may generate the only positive sample in an patients.

The sputum of patients with miliary tuberculosis is frequently smear negative. [9] Sputum agriculture results improve diagnostic yield nevertheless are useful only in survey [9] Although hepatic granulomas may be establish in 34 [10] to 67 percent [9] of these patients, the diagnosis can be established barely when they are associated with positive bacteriologic findings. [11 12] Marrow biopsy confirms the diagnosis in 33 percent [9] to 56 percent [13] patients. Percutaneous pulmonary aspiration and cutting needle biopsies, although useful, are associated with of common occurrence complications. [14] Fiberbronchoscopy not sole has a better yield further also is associated with notably fewer complications. It make secures a rapid diagnosis in chiefly patients and holds a tonic place in the investigation protocol of this condition.