Improving Diagnostic of Pulmonary Tuberculosis in HIV Patients by Bronchoscopy: A Cross Sectional Study
Background: diagnostic of pulmonary TB in HIV patients is a problem due to non specific clinical features, or radiological appearance. HIV patients with CD4≤200 cells/mL infected with M. tuberculosis have less capacity in containing M. tuberculosis, developing granulomas, casseous necrosis, or cavities. This condition is caused by weakend inflammatory which later reduced sputum production and may cause false negative result. This study aimed to assess differences in the positivity level of acid fast bacilli (AFB) and cultures of M. tuberculosis from non-bronchoscopic sputum (spontaneous and induced sputum) compared to bronchoscopic sputum (bronchoalveolar lavage) in HIV positive patients suspected pulmonary tuberculosis with CD4<200 cells/μL.
Methods: this cross sectional study was conducted in adult HIV patients treated in Hasan Sadikin Hospital with CD4≤200 cells/μL suspected with pulmonary tuberculosis by using paired comparative analytic test. All patients expelled sputum spontaneously or with sputum induction on the first day. On the next day, bronchoalveolar lavage (BAL) was performed. The two samples obtained from two methods were examined by AFB examination with staining Ziehl Neelsen (ZN) and cultured of M. tuberculosis on solid media Ogawa on all patients. Positivity, sensitivity and increased sensitivity of AFB and culture of M. tuberculosis in the non bronchoscopic and bronchoscopic groups were compared.
Results: there were differences in the positivity level of AFB with ZN staining between non-bronchoscopic and bronchoscopic groups which were 7/40 (17.5%) vs 20/40 (50.0%) (p<0.001). The differences between the cultures of non-bronchoscopic and bronchoscopic groups were 16/40 (40.0%) vs 23/40 (57.5%) (p=0.039). Bronchoscopic sputum increased the positivity level of the ZN AFB examination by 32.5% (from 17.5% to 50.0%) as well as on culture examination by 17.5% (from 40.0% to 57.5%).
Conclusion: Bronchoalveolar lavage can improve the positivity level of smears and cultures in patients suspected of pulmonary TB in HIV patients with CD4<200 cells/μL.
World Health Organization. Global tuberculosis report 2016 (global tuberculosis control). Switzerland: World Health Organization Press; 2016.
Getahun H, Harrington M, O’Brien R, Nunn P. Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resourceconstrained settings: informing urgent policy changes. Lancet. 2007;369:2042–9.
Karakousis PC, Chaisson RE. Mycobacterial infections and HIV infection. In: Fishman A, Elias J, Fishman J, Grippi M, Senior R, Pack A, eds. Fishman’s pulmonary disesase and disorders. 4ed. New York: Mc Graw Hill; 2008. p.2487-97.
Nachega JB, Maartens G. Clinical aspects of tuberculosis in HIV infected adults. In: Schaaf H, Zumla A, ed. Tuberculosis a comprehensive clinical reference. Europe: Saunders; 2009. p. 524-31.
Gupta P, Baloch Z. Pulmonary cytopathology. In: Fishman A, Elias J, Fishman J Grippi MA, Senior RM, Pack AI, ed. Fishman’s pulmonary disesase and disorders. 4ed. New York: Mc Graw Hill Medical; 2008. p511-610.
TB CARE I. International Standards for Tuberculosis Care, Edition 3. TB CARE I, The Hague, 2014.
Fangman JJW, Sax PE. Human immunodeficiency virus and pulmonary infections. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI, eds. Fishman’s pulmonary diseases and disorders. 4ed. New York: Mc Graw Hill Medical; 2008. p.2241–64.
Aderaye G, G/Egziabher H, Aseffa A, Worku A, Lindquist L. Comparison of acid-fast stain and culture for Mycobacterium tuberculosis in pre- and post-bronchoscopy sputum and bronchoalveolar lavage in HIV-infected patients with atypical chest X-ray in Ethiopia. Ann Thorac Med. 2007;2(4):154-7.
Worodria W, Davis J, Cattamanchi A, Andama A, Boon S, Yoo S. Bronchosocopy is useful for diagnosing smear-negative tuberculosis in HIV-infected patients. Eur Respir J. 2010;446-56.
Adewole OO, Onakpoya UU, Ogunrombi AB, et al. Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield, complications, and challenges in a Nigerian Tertiary Center. Niger J Clin Pract. 2017;20(1):77-81.
Garcia SB, Perin C, Silveira MMd, Vergani G, Menna-Barreto SS, Dalcin PdTR. Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital. J Bras Pneumol. 2009;35(11):1092-9.
Baughman RP, Lower EE. Diagnosis of pneumonia in immunocompromised patient. In: Agusti C, Torres A, Eds. Pulmonary infection in the immunocompromised patient: Strategi for management. UK: John Wiley and Sons. Ltd; 2009. p.65-70.
Vachini A, Seijo L, Unger M, Sterman D. Bronchoscopy, transthoracic needle aspiration, and related procedures. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI, eds. Fishman’s pulmonary diseases and disorders. 4th edition. New York: Mc Graw Hill Medical; 2008. p. 629-48.
Al-Zamel FA. Detection and diagnosis of Mycobacterium tuberculosis. Expert Rev Anti Infect Ther. 2009;7(9):1099-108.
Dinnes J, Deeks J, Kunst H, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess. 2007;11(3):1-155.
- There are currently no refbacks.