*Corresponding author: Girish N, E-mail girishdasanur@yahoo.co.in
Microbiological diagnosis is the main stay for the effective treatment of pulmonary tuberculosis. About 31% of the new cases may be smear-negative for AFB. Difficulties arise, when a patient who is suspected of active tuberculosis, both clinically and radiologically, does not produce sputum. Bronchoscopy offers a means of investigation whereby bronchial secretion and washing can be collected from the most likely abnormal site under direct vision.
To compare the diagnostic efficacy of sputum acid fast staining with BAL (Bronchoalveolar lavage) fluid acid fast staining in the early detection of pulmonary tuberculosis. To evaluate bronchoalveolar lavage specimens for the diagnosis of pneumonia caused by other pyogenic bacterial & fungal pathogens.
Fiberoptic bronchoscopy was performed on 53 adult patients who had persistent opacities on chest radiography in the form of collapse, consolidation, and cavity. Identification of bacteria and fungi was done as per standard procedures.
Fibreoptic bronchoscopy was diagnostic in 50 out of 53 (94%) patients. In these 53 patients, sputum acid fast staining was positive in 7 out of 53(13%) and BAL specimens were positive for acid fast bacilli in 36 out of 53(68%). Culture positivity of BAL specimens on LJ medium was 24 out of 50 (48%), 21 from smear positive BAL samples (42%) and 3 from smear negative BAL samples (6%). The analysis revealed Mycobacterial infection in 39 out of 50 (78%) patients. Pyogenic bacterial infections were caused by Klebsiella spp, S.aureus, E.coli, Pseudomonas spp. in 43 out of 50 (86%) specimens. Fungal infection by Candida, Aspergillus, Mucor was seen in 5 out of 50 (10%) of specimens.
BAL examination is of value not only in the diagnosis of sputum smear AFB negative pulmonary tuberculosis & patients who are unable to expectorate but also in diagnosing other pyogenic bacteria & fungi
Pulmonary tuberculosis, Fiberoptic bronchoscopy, BAL fluid
