ROLE OF BRONCHOALVEOLAR LAVAGE EXAMINATION IN CLINICALLY AND RADIOLOGICALY SUSPECTED SMEAR NEGATIVE PULMONARY TUBERCULOSIS

Mahendrasinh H Parmar; Prashant R Gohil; Akash Korvadiya; Pooja Patel; Jasu N Patel

Volume : VIII, Issue : XII, December - 2019

ROLE OF BRONCHOALVEOLAR LAVAGE EXAMINATION IN CLINICALLY AND RADIOLOGICALY SUSPECTED SMEAR NEGATIVE PULMONARY TUBERCULOSIS

Mahendrasinh H Parmar, Prashant R Gohil, Akash Korvadiya, Pooja Patel, Jasu N Patel

Abstract :

Introduction: Tuberculosis continues to be a major health problem worldwide with variable clinical presentations. In 2011, 8.7 million new cases of tuberculosis were reported and the highest cases were from Asia. India accounts for one fourth of the global TB burden i.e.2.2 million out of 9.6 million new cases annually. In India, more than 40% of population is infected (prevalence of infection) with Mycobacterium tuberculosis. Sputum examination for acid–fast bacilli (AFB) is simple and inexpensive, but it is positive in 44% of cases and even less in children. Approximately more than 50% of the pulmonary tuberculosis is sputum smear–negative .The diagnosis and treatment of these patients relies on clinical symptoms, but 20% are asymptomatic. The initiation of empirical therapy or employing other techniques can be challenging and time consuming because a physician is seeking to prove tuberculosis (1). Clinical and radiological based diagnosis can lead to either over– or under diagnosis of tuberculosis. Mortality of sputum smear–negative, culture–positive tuberculosis cases are about 14.1%, insisting on the importance of diagnosis of sputum smear–negative PTB (1, 2). On the other hand, unnecessary anti tuberculosis treatment may cause drug resistance and economic burden. Fieoptic Bronchoscopy (FOB) can provide an early confirmative diagnosis in such patients. Despite the fact that it is expensive and aggressive, it is generally accepted as an important technique in the diagnosis of PTB and provides useful material for diagnosis. Among the onchoscopic materials, onchoalveolar lavage (BAL) is the best diagnostic material for the diagnosis of PTB (3). Methodology: Patient who came to OPD in pulmonary medicine department, C. U. Shah Medical College was evaluated for respiratory symptoms and radiographic findings. After initial sputum smear negative, patient asked to go through sputum inducation. If smear negative after sputum induction then fiberoptic onchoscopy done for Bronchoalveolar Lavage. Result: In our study total 168 patients are clinically and radiologically suspected for tuberculosis in which we found 77% patient�s BAL is positive for tuberculosis after exclude initial & sputum inducation sample AFB is positive. Conclusion: Fiberoptic onchoscopy is superior then sputum induction for diagnosis of tuberculosis in smear negative patient and also to rule out condition other than tuberculosis.