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Abstract
Purpose
To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have difficulty in sputum expectoration.
Methods
The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and immunologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB-suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum specimen or in the bronchial washing fluid.
Results
A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the re-maining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the sputum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tuberculosis. None of the patients had significant complications due to bronchoscopy.
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Fig. 1.
Flow diagram of patients included in the study. M. TB, Mycobacterium tuberculosis; PCR, polymerase chain reaction; AFB, acid fast bacilli.
Table 1.
Demographic and clinical characteristics of all patients
Table 2.
The results of laboratory tests for the 7 pulmonary TB patients
| Case | Sex/age (yr) | Previous TB Hx | Contact TB Hx | Symptom | Radiologist reading suspecting TB | Radiologic finding | Bronchoscopic finding | TST (mm) | IGRA | Washing fluid laboratory results | M. TB sensitivity | Treatment | Outcome | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| M. TB PCR | AFB smear | M. TB Cx. | Other result | ||||||||||||||
| A∗ | 1 | F/16 | (-) | (-) | Cough | (+) | Nodule, cavity | Not done | 0 | (+) | Sputum (+) | Sputum (+) | Sputum (+) | (-) | All S | HERZ+HER | Improved |
| B† | 1 | F/15 | (-) | (+) | Cough, sputum, hemoptysis | (+) | Consolidation, LAP, nodule, tree in bud | RLL bronchus swelling | 0 | NA | (+) | (+) | (+) | (-) | INH R+ | HERZ | F/U loss |
| 2 | F/11 | (-) | (-) | Cough, fever | (+) | Consolidation, nodule, GGO | RLL bronchus swelling | 10 | (-) | (+) | (+) | (+) | (-) | All S | HERZ+HER | Improved | |
| 3 | F/14 | (-) | (-) | Cough, sputum, fever, night sweats | (+) | Consolidation, LAP, GGO, effusion | N/S | 25 | (+) | Sputum (-)(+) | Sputum (-) (-) | Sputum (+) (+) | Rhino virus | All S | HERZ+HR | Improved | |
| 4 | F/14 | (-) | (+) | Dyspnea | (+) | Nodular opacity | RUL bronchus inflammation | NA | (+) | (+) | (-) | (+) | (-) | All S | HERZ+HR | Improved | |
| 5 | M/17 | (-) | (+) | (-) | (+) | Nodule, tree in bud | N/S | 10 | (+) | (-) | (-) | (+) | (-) | INH R+, PTH R+ | H ERZ(9) | Improved | |
| 6 | F/16 | (-) | (-) | Cough | (+) | Consolidation, LAP, nodule | Right main bronchus narrowing | 17 | (+) | (+) | (+) | (+) I | Influenza virus | All S | HERZ+HR | Improved | |
TB Hx, tuberculosis history; TST, tuberculin skin test; IGRA, interferon-γ release assays; M. TB, Mycobacterium tuberculosis; PCR, polymerase chain reaction; AFB, acid fast bacilli; Cx., culture; LAP, lymphadenopathy; RLL, right lower lobe; NA, not available INH, isoniazid; HERZ, isoniazid+ethambutol+rifampicin+pyrazinamid; F/U, follow-up; GGO, ground-glass opacity; N/S, nonspecific; HR, isoniazid+rifampicin; RUL, right upper lobe; PTH, prothionamide. ∗A, pulmonary tuberculosis (PTB) patient confirmed by only sputum test;
Table 3.
The results of laboratory tests for the 9 nonpulmonary TB patients
TB Hx, tuberculosis history; TST, tuberculin skin test; IGRA, interferon-γ release assays; M. TB, Mycobacterium tuberculosis; PCR, polymerase chain reaction; AFB, acid fast bacilli; Cx., culture; LLL, left lower lobe; NA, not available; MPP, Mycoplasma pneumo-eumonia; LAP, lymphadenopathy; GGO, ground-glass opacity; LUL, left upper lobe; RUL, right upper lobe; AMX-CLA, amoxicillin-clavulanate; N/S, nonspecific; E. facium, Enterococcus faecium; LUL, left upper lobe; RUL, right upper lobe; VATS, video as-ed thoracoscopy.
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