Source: International Congress 2015 – Case series and clinical conundrums in TB
Disease area: Respiratory infections

Abstract

Background:Smear negative tuberculosis (SNTB) was defined[1]as radiological and/or clinical suspicion of TB (tuberculosis) in patients with 3 negative smears or who are unable to produce sputum.Obtaining a microbiological proof is essential in order to perform DST (drug susceptibility testing).Aims & Objectives:The goal of this study was to compare the role of both induced sputum (IS) and bronchoscopy with broncho-alveolar lavage (BAL) and transbronchial biopsies (TBB) in obtaining a diagnosis.Methods:From 09-2009 until 12-2014 we prospectively randomized 150 consecutive patients with suspicion of SNTB after obtaining written informed consent. They were randomly assigned to either two IS-procedures on different days or bronchoscopy with BAL and TBB (under fluoroscopic guidance).Results:Final microbiological proof of TB was obtained by IS in 13/75 patients and in 15/75 by bronchoscopy.Quick results were available by IS in 3/13 positive patients (smear/PCR) and by bronchoscopy in 6/15 patients (smear/PCR) or 11/15 (smear/PCR/histology).In 5 patients undergoing bronchoscopy, alternative diagnoses were also obtained (2 NSCLC, 3 BOOP).Performance of the 2 methods will be calculated as soon as follow-up is long enough.Conclusions:Overall microbiological results did not differ between two tests, but bronchoscopy showed better performance in smear and PCR results. In addition, information obtained through histological analysis of TBB gave significant supplementary information including inflammation suggestive for TB or alternative diagnoses.[1] WHO Treatment of Tuberculosis Guidelines, 2003.


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Inge Muylle (Anderlecht, Belgium), Inge Muylle, Marie-Christine Payen, Maria Gabrovska, Peter Rummens, Vincent Ninane. Induced sputum or bronchoscopy in smear negative tuberculosis: A randomized study. Eur Respir J 2015; 46: Suppl. 59, 2763

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