Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Fatima Jinnah General and Chest Hospital, Quetta, Pakistan.
Adv Respir Med. 2020;88(5):389-393. doi: 10.5603/ARM.a2020.0149.
The presence of Mycobacterium tuberculosis in a respiratory specimen is diagnostic in patients with pleural effusion. It is difficult to obtain sputum even after induction in these patients. An alternative method of acquiring respiratory specimens is via bronchial lavage. This study was undertaken to evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, AFB culture, and Xpert assay of bronchial lavage fluid in the workup of pleural tuberculosis patients.
All patients who met the inclusion criteria of the study underwent thoracentesis, pleural biopsy, and bronchial lavage. Specimens of pleural fluid, pleural biopsy, and bronchial lavage fluid were sent for acid fast bacilli smear, culture, and Xpert assay.
Bronchial lavage AFB smear, culture, and Xpert assay was positive in 9.5%, 17.9%, and 26.2% of patients, respectively. It gave an immediate diagnosis in 22 (26.2%) patients.
Bronchial lavage, though not a surrogate to pleural biopsy, offers an additional approach to the early diagnosis of pleural tuberculosis in patients not producing sputum. Besides being diagnostic, this method also has epidemiologic significance in containing the tuberculosis epidemic because detecting Mycobacterium in bronchial lavage confirms that the patient is infectious.
在胸腔积液患者的呼吸道标本中发现结核分枝杆菌即可确诊。即使经过诱导，这些患者也很难咳出痰液。获取呼吸道标本的另一种方法是通过支气管灌洗。本研究旨在评估支气管灌洗液中抗酸杆菌（AFB）涂片、AFB 培养和 Xpert 检测在胸腔结核患者检查中的诊断效果。
所有符合研究纳入标准的患者均接受了胸腔穿刺术、胸膜活检和支气管灌洗。胸腔积液、胸膜活检和支气管灌洗液标本均用于抗酸杆菌涂片、培养和 Xpert 检测。
支气管灌洗 AFB 涂片、培养和 Xpert 检测的阳性率分别为 9.5%、17.9%和 26.2%。它立即诊断了 22 名（26.2%）患者。
支气管灌洗虽然不能替代胸膜活检，但为不产生痰液的胸腔结核患者提供了一种早期诊断的额外方法。除了具有诊断意义外，该方法在控制结核病流行方面也具有流行病学意义，因为在支气管灌洗液中检测到分枝杆菌证实患者具有传染性。
