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Study of bronchoalveolar lavage in clinically and radiologically suspected cases of pulmonary tuberculosis  [cached]
Kalawat Usha,Sharma Krishna,Reddy Prakash,Kumar A
Lung India , 2010,
Abstract: Context: About 30 to 50 % of pulmonary tuberculosis patients have sputum report negative for acid fast bacilli or present with no expectoration. A lot of research is going on to find methods to establish early and accurate diagnosis of pulmonary tuberculosis (PTB) as institutions of early treatment can have significant effects on morbidity and mortality of patients and also the development of MDR-TB. Samples other than sputum play an important role in the diagnosis of disease in such patients. Aims: To assess the significance of bronchoalveolar lavage samples and fiberoptic bronchoscopy (FOB) in the early diagnosis of occult sputum smear negative pulmonary tuberculosis. Settings and Design: Study was conducted in a tertiary care hospital. FOB was performed in patients with three consecutive sputum smear negative acid fast bacilli to obtain bronchoalveolar lavage (BAL) samples. Written informed consent was obtained from these patients. Materials and Methods: BAL samples were subjected to Z-N staining and culture on L-J slopes for acid fast bacilli. Sputum samples from the same patients were also cultured. Results: BAL samples were positive in 82.2% of sputum smear negative samples. Culture positivity of BAL samples was 90.9% as compared to sputum culture positivity which was 26.4%. Overall diagnosis could be established in 86.6% of patients with the help of fiber optic bronchoscopy. Conclusions: BAL samples are very useful in early sputum smear negative pulmonary tuberculosis and FOB can play an important role in diagnosis of lower respiratory tract infections with minimal complications in hands of an expert.
Effectiveness of the BDProbeTec ET system for detection of Mycobacterium tuberculosis complex in sputum and bronchoalveolar lavage specimens
Hung, Hung-Chang;Chan, Chi-Ho;Tsao, Shih-Ming;Chen, Shiuan-Chih;Wu, Tzu-Chin;Lu, Min-Chi;Wu, Der-Jinn;Huang, Shu-Ju;Lee, Yuan-Ti;
Brazilian Journal of Infectious Diseases , 2012, DOI: 10.1590/S1413-86702012000300005
Abstract: objective: the diagnostic efficacy of the bdprobetec et mycobacterium tuberculosis (mtb) complex direct detection assay (dtb) performed on bronchoalveolar lavage (bal) specimens and sputum smears was compared with acid-fast bacilli (afb) smear microscopy. method: afb smear microscopy, dtb and culture results of 286 patients with pulmonary tuberculosis were retrospectively reviewed. a total of 120 patients provided expectorated sputum samples, and 166 patients provided bal specimens. culture results and clinical diagnosis were used as gold standards. results: the sensitivity and specificity of the dtb assay in detecting mtb in sputum specimens was significantly higher compared to afb smear microscopy (83.7% and 82.4%, vs. 75.6%, and 41.2%, respectively). the sensitivity and specificity of the dtb assay in detecting mtb in sputum samples was 77.2% and 100% compared to clinical diagnosis, while afb smear had a sensitivity and specificity of 70.3% and 26.3%, respectively. compared to culture, dtb had a sensitivity and specificity of 82.8% and 93.2%, respectively, in detecting mtb from bal specimens; afb smear had a sensitivity and specificity of 41.9% and 87.7%, respectively. compared to clinical diagnosis, dtb had a sensitivity and specificity of 67.2% and 100%, respectively, in detecting mtb from bal specimens; afb smear had a sensitivity and specificity of 34.8% and 79.5%, respectively. conclusions: the superior performance of the dtb assay relative to afb smear microscopy makes it a valuable tool to enable early diagnosis of mtb, thereby improving patient care and reducing transmission.
Increased Production of IL-4 and IL-12p40 from Bronchoalveolar Lavage Cells Are Biomarkers of Mycobacterium tuberculosis in the Sputum  [PDF]
Anna Nolan, Elaine Fajardo, Maryann L. Huie, Rany Condos, Anil Pooran, Rodney Dawson, Keertan Dheda, Eric Bateman, William N. Rom, Michael D. Weiden
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0059461
Abstract: Background Tuberculosis (TB) causes 1.45 million deaths annually world wide, the majority of which occur in the developing world. Active TB disease represents immune failure to control latent infection from airborne spread. Acid-fast bacillus (AFB) seen on sputum smear is a biomarker for contagiousness. Methods We enrolled 73 tuberculosis patients with extensive infiltrates into a research study using bronchoalveolar lavage (BAL) to sample lung immune cells and assay BAL cell cytokine production. All patients had sputum culture demonstrating Mycobacterium tuberculosis and 59/73 (81%) had AFB identified by microscopy of the sputum. Compared with smear negative patients, smear positive patients at presentation had a higher proportion with smoking history, a higher proportion with temperature >38.50 C, higher BAL cells/ml, lower percent lymphocytes in BAL, higher IL-4 and IL-12p40 in BAL cell supernatants. There was no correlation between AFB smear and other BAL or serum cytokines. Increasing IL-4 was associated with BAL PMN and negatively associated with BAL lymphocytes. Each 10-fold increase in BAL IL-4 and IL-12p40 increased the odds of AFB smear positivity by 7.4 and 2.2-fold, respectively, in a multi-variable logistic model. Conclusion Increasing IL-4 and IL-12p40 production by BAL cells are biomarkers for AFB in sputum of patients who present with radiographically advanced TB. They likely reflect less effective immune control of pathways for controlling TB, leading to patients with increased infectiousness.
Predictive Role of ADA in Bronchoalveolar Lavage Fluid in Making the Diagnosis of Pulmonary Tuberculosis  [PDF]
Fariba Binesh,Abolhassan Halvani
Pulmonary Medicine , 2013, DOI: 10.1155/2013/851518
Abstract: Current diagnostic tests for tuberculosis (TB) are time-consuming. The aim of this study was to evaluate the diagnostic usefulness of ADA in bronchoalveolar lavage fluid in patients with pulmonary TB. A cross-sectional study was performed in Yazd, Iran, between 2009 and 2010. Patients suspected of pulmonary TB with negative sputum smear for AFB were included in the study. Mean ADA levels in BAL fluids were measured and compared between study groups. Sixty-three patients were enrolled in the study among which 15 cases had pulmonary TB, 33 had pulmonary diseases other than TB, and 15 subjects with normal bronchoscopy results were considered as controls. Mean ADA levels in BAL fluid were , , and , respectively. This rate was significantly higher in the pulmonary TB group compared to the other two groups ( ). Using ROC curve with a cut-off value of 3.5?IU/L, the highest sensitivity (57%) and specificity (84%) were obtained in diagnosis of TB. The results showed that although ADA activity in BAL fluid of pulmonary TB patients was higher than those seen in other diseases, a negative test does not rule out pulmonary TB. 1. Introduction Tuberculosis (TB) is the second most important cause of death from infectious diseases in the world [1]. It is a major public health problem in developing countries including Iran. Multidrug resistance in tuberculosis and its association with acquired immunodeficiency syndrome (AIDS) have further highlighted the importance of this disease. The diagnosis is usually based on clinical presentation, radiologic findings, and positive tuberculin and/or skin tests. However, clinicoradiological features are variable and the latter tests may be falsely negative. The gold standard of TB diagnosis requires the growth of Mycobacterium in specimen cultures, but the cultures are time-consuming and have low positivity rates, with a mean sensitivity of 43%–83% depending on the quality of samples cultured and methods utilized [2]. Since delay is unacceptable in emergency situations, it is necessary to find faster methods with higher sensitivity. The polymerase chain reaction (PCR) assay has shown good sensitivity and specificity in some studies [3], but it is not cost-effective and few centers use it in Iran. Several biomarkers like adenosine deaminase (ADA), interferon gamma (IFN-γ), and a variety of tumor markers and cytokines have been proposed as alternative noninvasive means of establishing tuberculous etiology [4]. ADA is an enzyme involved in purine catabolism, catalyzing the pathway from adenosine to inosine and is known as a cellular
Use of fibreoptic bronchoscopy in increasing diagnostic yield in smear negative tubercular pleural effusion  [cached]
Gupta K,Chopra Puneet
Lung India , 2007,
Abstract: Setting: Department of Tuberculosis and Respiratory diseases, Pt. B.D. Sharma PGIMS, Rohtak. Aim: Study was carried out to evaluate the diagnostic yield of fibreoptic bronchos-copy in patients of smear negative tubercular pleural effusion. Methodology: Flexible fibreoptic bronchoscopy under local anaesthesia was car-ried out and bronchoalveolar lavage was stained by Z-N staining for AFB and en-dobronchial biopsy was sent for histopathological examination and direct staining for AFB. Results: Endobronchial abnormalities were visualised in nearly 50% cases in right sided pleural effusion and 38% cases in left sided pleural effusion. Bronchoalveolar lavage was positive for AFB in 8% of cases. Endobronchial biopsy for histopathol-ogy and staining for AFB was positive in 12% of cases. Conclusion: Flexible fibreoptic bronchoscopy is very safe and novel technique in increasing bacteriological yield of patients with tubercular pleural effusion.
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  [cached]
Aderaye Getachew,G/Egziabher Haimanot,Aseffa Abraham,Worku Alemayehu
Annals of Thoracic Medicine , 2007,
Abstract: Background : 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. Aims : To evaluate the relative yield of pre- and post-bronchoscopy sputum and bronchoalveolar lavage (BAL) in ′sputum smear′-negative, HIV-positive patients. Settings : A tertiary care referral hospital in Addis Ababa. Materials and Methods : 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. Results : 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). Conclusion: 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.
Sarcoidosis and Tuberculosis Cytokine Profiles: Indistinguishable in Bronchoalveolar Lavage but Different in Blood  [PDF]
Muhunthan Thillai, Christian Eberhardt, Alex M. Lewin, Lee Potiphar, Suzie Hingley-Wilson, Saranya Sridhar, Jonathan Macintyre, Onn Min Kon, Melissa Wickremasinghe, Athol Wells, Mark E. Weeks, Donald Mitchell, Ajit Lalvani
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038083
Abstract: Background The clinical, radiological and pathological similarities between sarcoidosis and tuberculosis can make disease differentiation challenging. A complicating factor is that some cases of sarcoidosis may be initiated by mycobacteria. We hypothesised that immunological profiling might provide insight into a possible relationship between the diseases or allow us to distinguish between them. Methods We analysed bronchoalveolar lavage (BAL) fluid in sarcoidosis (n = 18), tuberculosis (n = 12) and healthy volunteers (n = 16). We further investigated serum samples in the same groups; sarcoidosis (n = 40), tuberculosis (n = 15) and healthy volunteers (n = 40). A cross-sectional analysis of multiple cytokine profiles was performed and data used to discriminate between samples. Results We found that BAL profiles were indistinguishable between both diseases and significantly different from healthy volunteers. In sera, tuberculosis patients had significantly lower levels of the Th2 cytokine interleukin-4 (IL-4) than those with sarcoidosis (p = 0.004). Additional serum differences allowed us to create a linear regression model for disease differentiation (within-sample accuracy 91%, cross-validation accuracy 73%). Conclusions These data warrant replication in independent cohorts to further develop and validate a serum cytokine signature that may be able to distinguish sarcoidosis from tuberculosis. Systemic Th2 cytokine differences between sarcoidosis and tuberculosis may also underly different disease outcomes to similar respiratory stimuli.
Expression of Fas antigen and Fas ligand in bronchoalveolar lavage from silicosis patients  [PDF]
Agnès Hamzaoui,Jamel Ammar,Hédia Gra ri,Kamel Hamzaoui
Mediators of Inflammation , 2003, DOI: 10.1080/09629350310001599648
Abstract: Objective: To understand the role of apoptosis through Fas/Fas ligand (FasL) interaction in the pathogenesis of silicosis, we examined the expression of Fas antigen, FasL and apoptosis in bronchoalveolar lavage fluid lymphocytes obtained from patients with silicosis.
The role of fibronectin in bronchoalveolar lavage fluid of asthmatic patients.
Ohke M,Tada S,Nabe M,Matsuo K
Acta Medica Okayama , 2001,
Abstract: Allergic and chronic inflammation of the airway is regarded as the main pathogenesis of bronchial asthma, in which adhesion of inflammatory cells requires the expression of adhesion molecules. Thus, to clarify the role of fibronectin (FN) in the airway inflammation of bronchial asthma, FN levels in plasma and bronchoalveolar lavage fluid (BALF) from bronchial asthmatics were determined. FN concentrations in plasma and BALF were measured by enzyme-linked immunosorvent assay (ELISA) in 17 asthmatic patients and 10 healthy controls to elucidate the role of FN in allergic inflammation. The mean FN/albumin (Alb) level in the BALF of asthmatic patients was 2.973 micrograms/mg, which was significantly higher than that of healthy controls (0.727 microgram/mg). Non-atopic asthmatics showed a significantly higher level of FN in their BALF in comparison with atopic asthmatics, although the ratio of FN to albumin showed no significant difference. FN levels in BALF correlated significantly with total cell density (r = 0.71, P < 0.05) and alveolar macrophage density (r = 0.64, P < 0.05). FN levels in plasma did not correlate with those in BALF. In conclusion, increased FN in BALF, which was produced locally in the airways of asthmatic patients, is actively involved in the regulation of allergic inflammation.
Predictive value of the acid fast smear for detection of Mycobacterium tuberculosis in respiratory specimens in a Reference Center of HIV/Aids in Rio de Janeiro, Brazil
Conde, Marcus B;Figueira, Cesar M;Moraes, Renata;Fonseca, Leila S;DeRiemer, Kathy;Kritski, Afranio L;
Memórias do Instituto Oswaldo Cruz , 1999, DOI: 10.1590/S0074-02761999000600014
Abstract: in order to evaluate the predictive value of acid fast bacilii (afb) smear for the diagnosis of mycobacterium tuberculosis in respiratory specimens in a setting with a high prevalence of aids and an unknown prevalence of nontuberculous mycobacteria (ntm), we retrospectively examined specimens cultured for mycobacteria between 1 september 1993 and 30 september 1994 and medical records of patients with positive culture in a general hospital, aids reference in rio de janeiro, brazil. seventy three per cent (1517/2077) of samples were respiratory specimens and mycobacteria were recovered from 20.6% (313/1517) of these. m. tuberculosis was identified in 94.2% (295/313) and ntm in 5.8% (18/313). the yield of positive afb smear and of positive culture was 6.1% (93/1517) and 20.6% (313/1517), respectively. the positive predictive value (ppv) of afb for m. tuberculosis was 98.4% in expectorated sputum and 96.4% in bronchoalveolar lavage. forty four percent (130/295) of specimens with positive culture for m. tuberculosis and 66.7% (12/18) for ntm were from patients hiv positive. the conclusion was that in our study population, the ppv of afb for m. tuberculosis in respiratory specimens was high and the prevalence of ntm was low despite the high prevalence of hiv positive.
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