Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD® Gen-probe testing

Summary Introduction In our institution, patients with suspected pulmonary TB undergo multiple induced-sputum sampling for microscopy, culture and nucleic acid amplification (NAA) with the MTD® Gen-probe assay. Those with negative induced-sputum results still suspected with TB are then referred for...

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Bibliographic Details
Published in:	Respiratory medicine Vol. 105; no. 7; pp. 1084 - 1090
Main Authors:	Iyer, Vivek N, Joshi, A.Y, Boyce, T.G, Brutinel, M.W, Scalcini, M.C, Wilson, J.W, McCoy, Kevin, Aksamit, T.R
Format:	Journal Article
Language:	English
Published:	Kidlington Elsevier Ltd 01-07-2011 Elsevier Elsevier Limited
Subjects:	Adolescent Adult Aged Aged, 80 and over Bacterial diseases Bacterial diseases of the respiratory system Biological and medical sciences Bronchoscopy Bronchoscopy - methods Female Human bacterial diseases Humans Infectious diseases Male Medical sciences Middle Aged Mycobacterium tuberculosis - genetics Nucleic acid amplification (NAA) Nucleic Acid Amplification Techniques - methods Pneumology Pulmonary/Respiratory Retrospective Studies Sputum - microbiology Sputum - secretion Tuberculin skin test (TST) Tuberculosis (TB) Tuberculosis and atypical mycobacterial infections Tuberculosis, Pulmonary - diagnosis Tuberculosis, Pulmonary - microbiology Tuberculosis, Pulmonary - pathology Young Adult Tuberculosis (TB) Bronchoscopy Tuberculin skin test (TST) Nucleic acid amplification (NAA) Lung disease Respiratory disease Pulmonary tuberculosis Exploration Mycobacterial infection Tuberculin Probe Infection Amplification Acids Sputum Bacteriosis Smear Endoscopy Pneumology Skin test
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Summary:	Summary Introduction In our institution, patients with suspected pulmonary TB undergo multiple induced-sputum sampling for microscopy, culture and nucleic acid amplification (NAA) with the MTD® Gen-probe assay. Those with negative induced-sputum results still suspected with TB are then referred for bronchoscopy. We sought to determine the diagnostic yield of bronchoscopy in these patients with negative initial induced-sputum results both via smear and NAA testing. Methods We identified 30 consecutive cases of suspected pulmonary TB between 2001 and 2007, who had undergone a diagnostic bronchoscopy after negative results on induced-sputum smears and the MTD® Gen-probe on at least 2 samples. Results The cohort (M = 20 & F = 10) had a median age of 37 (range 16–85 yrs); were predominantly foreign born (27/30); HIV-negative (29/30) individuals with strongly positive TST's (mean 18 + 5 mm). Induced-sputum cultures were negative for M-TB in all patients after a full 60-day incubation period. BAL was culture positive for M-TB in 3/30 cases (10%) with 2 strains being pan-sensitive and the third being INH resistant. BAL microscopy with acid-fast smear ( n = 30) and BAL Gen-probe ( n = 23) were negative in all cases. A third of the patients (9/27, 33%) with negative bronchoscopy results were treated for culture negative TB. Treatment for latent TB was initiated in 5/27 (18%) individuals whereas 13/27 (48%) received no further treatment. Conclusion Bronchoscopy provided diagnostic confirmation of pulmonary TB in 10% of subjects at least 2 negative induced-sputum samples by smear microscopy and NAA testing.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0954-6111 1532-3064
DOI:	10.1016/j.rmed.2011.03.003