Khan Fahmi Yousef, Aladab Aisha Hussein
Department of Medicine, Hamad General Hospital, Doha, Qatar.
Pulmonary Division, Department of Medicine, Hamad General Hospital, Doha, Qatar.
Oman Med J. 2020 Jan 15;35(1):e87. doi: 10.5001/omj.2020.05. eCollection 2020 Jan.
We sought to evaluate the role of bronchoscopy-related procedures such as bronchoalveolar lavage (BAL), bronchial wash (BW), bronchial brush (B brush), transbronchial biopsy (TBB), and post-bronchoscopy sputum (PBS), alone or in combination, in the rapid diagnosis of negative sputum smear disseminated tuberculosis (TB).
We performed a secondary post hoc analysis of data collected from our previous study entitled "Disseminated tuberculosis among adult patients admitted to Hamad General Hospital, Qatar: A five-year hospital-based study" with a modified objective.
We identified 27 patients. BAL fluid was positive for acid-fast bacilli (AFB) smear in 7/27 (25.9%) patients and were culture-positive for in 17/27 (63.0%) cases, while BW collections were smear-positive in 9/27 (33.3%) cases and culture-positive for in 18/27 (66.7%) cases. TBB showed caseating granulomas in 10/16 (62.5%) cases and one case of non-caseating granuloma (6.3%). PBS was positive for AFB in 4/8 (50.0%) patients. The combination of these procedures enabled us to diagnose disseminated TB rapidly in 22 (81.5%) cases.
Bronchoscopy proved to be an effective method for the rapid diagnosis of disseminated TB in patients in whom sputum smear microscopy was negative.
我们试图评估支气管肺泡灌洗（BAL）、支气管冲洗（BW）、支气管刷检（B刷检）、经支气管活检（TBB）和支气管镜检查后痰液（PBS）等支气管镜相关操作单独或联合使用在痰涂片阴性的播散性肺结核（TB）快速诊断中的作用。
我们对之前一项名为“卡塔尔哈马德总医院成年住院患者中的播散性肺结核：一项基于医院的五年研究”的数据进行了二次事后分析，分析目的有所修改。
我们确定了27例患者。BAL液中7/27（25.9%）的患者抗酸杆菌（AFB）涂片呈阳性，17/27（63.0%）的病例培养呈阳性；而BW采集物中9/27（33.3%）的病例涂片呈阳性，18/27（66.7%）的病例培养呈阳性。TBB在10/16（62.5%）的病例中显示干酪样肉芽肿，1例为非干酪样肉芽肿（6.3%）。PBS在4/8（50.0%）的患者中AFB呈阳性。这些操作联合使用使我们能够在22例（81.5%）病例中快速诊断出播散性TB。
对于痰涂片显微镜检查阴性的患者，支气管镜检查被证明是快速诊断播散性TB的有效方法。
