ROLE OF FIBEROPTIC BRONCHOSCOPY IN PATIENTS WITH SPUTUM SMEAR NEGATIVE FOR ACID FAST BACILLI AND CHEST X - RAY SUGGESTIVE OF PULMONARY TUBERCULOSIS
Journal of Evidence Based Medicine and Healthcare
AIMS: To study the role of fiberoptic bronchoscopy in patients with sputum smear negative for AFB and chest X-ray suggestive of pulmonary tuberculosis. SETTINGS AND DESIGN: After informed consent, 60 adult patients with sputum smear negative for Acid Fast Bacilli (AFB) and chest X-ray (CXR) suggestive of pulmonary tuberculosis (PTB), underwent diagnostic fiberoptic bronchoscopy (FOB) as per British Thoracic Society (BTS) guidelines. Relevant sampling methods like bronchoalveolar lavage (BAL),
... lar lavage (BAL), brushings and biopsy were done and samples were analyzed by smear microscopy, histopathology and or culture methods on case per case basis. The values obtained were tabulated & statistically analyzed, the results with P value < 0.05 were considered statistically significant. RESULTS: Males constituted majority of our study population 48 (80%). The most common age group involved in the study was 40-49 years (41.7%). Cough was the most common symptom reported by all 60 patients (100%). 16 patients (26.66%) had past history of PTB. Majority of the study population, 47 patients had unilateral lesions on CXR (78.33%) had unilateral lesion on CXR. The final diagnosis of PTB was established in 42 (70%) cases. Immediate diagnosis of PTB was possible in 33 cases (55%). The diagnosis other than PTB was established in 5 cases (8.33%), which included 2 cases (3.33%) of lung cancer, 2 cases (3.33%) of fungal (Candida) pneumonia, and 1 case (1.66%) of bacterial (Klebshiella sp) pneumonia. CONCLUSIONS: Diagnostic yield of fiberoptic bronchoscopy was 70% in suspected cases of PTB with sputum smear for AFB negative, which makes it a necessary tool in all cases with X-ray suggestive of PTB, it's also a safe procedure considering the minimal complications in our selected cases. Considering FOB under RNTCP for diagnosis of suspected cases of sputum smear negative cases through public private partnership may add to the success of national program.