Department of Internal Medicine, Medical Faculty, Addis Ababa University, Ethiopia.
Ann Thorac Med. 2007 Oct;2(4):154-7. doi: 10.4103/1817-1737.36549.
Smear-negative tuberculosis occurs more frequently in human immunodeficiency virus (HIV)-infected patients than in non-HIV-infected patients. Besides, there are substantial numbers of patients who cannot produce sputum, making the diagnosis of pulmonary tuberculosis (PTB) difficult.
To evaluate the relative yield of pre- and post-bronchoscopy sputum and bronchoalveolar lavage (BAL) in 'sputum smear'-negative, HIV-positive patients.
A tertiary care referral hospital in Addis Ababa.
Acid-fast stain (AFS) using the concentration technique was done on 85 pre-bronchoscopy sputum and 120 BAL samples. Direct AFS was done on all BAL and 117 post-bronchoscopy sputum samples. Culture for Mycobacterium tuberculosis (MTB) was done for all sputa and BAL.
MTB was isolated from 26 (21.7%), 23 (19.7%) and 13 (15.3%) of BAL, post- and pre-bronchoscopy sputum cultures respectively. AFS on pre-bronchoscopy sputum using concentration technique and direct AFS on BAL together detected 11 (41%) of the 27 culture-positive cases. In patients who could produce sputum, the sensitivity of pre-bronchoscopy sputum culture (13/85, 15.3%) was comparable to BAL (12/85, 14%) and post-bronchoscopy sputum (12/85, 14%). In patients who could not produce sputum, however, both BAL (12/35, 40%) and post-bronchoscopy sputum (12/32, 31.4%) detected significantly more patients than those who could produce sputum (P=0.002, P=0.028 respectively).
In HIV-infected patients, AFS by concentration method on pre-bronchoscopy sputum and direct AFS on BAL in patients who cannot produce sputum are the preferred methods of making a rapid diagnosis. BAL culture seems to add little value in patients who can produce sputum; therefore, bronchoscopy should be deferred under such circumstances.
在人类免疫缺陷病毒（HIV）感染患者中，比非 HIV 感染患者更常发生涂片阴性结核病。此外，还有大量无法产生痰液的患者，这使得肺结核（PTB）的诊断变得困难。
评估“痰涂片”阴性、HIV 阳性患者支气管镜检查前后痰和支气管肺泡灌洗（BAL）的相对产量。
亚的斯亚贝巴的一家三级保健转诊医院。
使用浓缩技术对 85 例支气管镜检查前痰和 120 例 BAL 样本进行抗酸染色（AFS）。直接 AFS 用于所有 BAL 和 117 例支气管镜检查后痰样本。所有痰液和 BAL 均进行分枝杆菌结核（MTB）培养。
从 BAL、支气管镜检查后和支气管镜检查前痰液培养中分别分离出 MTB 26（21.7%）、23（19.7%）和 13（15.3%）例。使用浓缩技术的支气管镜检查前痰液 AFS 和 BAL 的直接 AFS 一起检测到 27 例培养阳性病例中的 11 例（41%）。在能够产生痰液的患者中，支气管镜检查前痰液培养的敏感性（13/85，15.3%）与 BAL（12/85，14%）和支气管镜检查后痰液（12/85，14%）相当。然而，在无法产生痰液的患者中，BAL（12/35，40%）和支气管镜检查后痰液（12/32，31.4%）均比能够产生痰液的患者检测到更多的患者，差异具有统计学意义（P=0.002，P=0.028）。
在 HIV 感染患者中，支气管镜检查前痰液浓缩法 AFS 和无法产生痰液患者的 BAL 直接 AFS 是快速诊断的首选方法。在能够产生痰液的患者中，BAL 培养似乎没有增加多少价值；因此，在这种情况下应推迟支气管镜检查。
