October - LRS Institute of Tuberculosis & Respiratory Diseases

D.D.S. KULPATI AND H.S. HEERA
10% and 5% respectively. Thus, the diagnosis of
mycobacterial disease would probably not have
been confirmed, had bronchoscopy not been
performed in 10% to 40% of suspected cases of
pulmonary tuberculosis. Wallace et al. (1981)
and Danek and Bower (1979) have reported 95%
culture positivity of specimens obtained by FFB and
therefore negative culture provided strong evidence
against tuberculosis. FFB is also helpful to
diagnose associated diseases and to obtain
specimens in patients who are unable to produce
sputum or produce very scanty sputum. Postbronchoscopic
sputum studies provide excellent
collaborative evidence in smear negative tuberculosis.
Flexible fiberoptic bronchoscopy in combination with
TBB provided early diagnosis (60 to 85%) in smear
negative pulmonary tuberculosis in other studies.
In our study, it also provided the exclusive diagnosis
in 40 % of patients on culture of bronchial aspirate
obtained by FFB.
Our study suggests that fiberoptic bronchoscopy
(FOB) can provide excellent material for
diagnosis of suspected cases of pulmonary
tuberculosis from whom smears of expectorated
sputum do not reveal mycobacteria or from whom
no sputum can be obtained. Secondly, FOB
combined with transbronchial lung biopsy may
provide early diagnosis of tuberculosis. Thirdly, in
cases of diffuse infiltrative tubercular disease, main
stress should be on transbronchial lung biopsy while
in cavitary tuberculosis bronchial washings are
more likely to be diagnostic. Efforts should be
made to get the post-bronchoscopic expectorated
sputum. It is advisable to culture the biopsy
material or bronchial brushings.
Acknowledgement
Our sincere thanks to Dr. K.B. Sharma, Dean,
Maulana Azad Medical College, New Delhi, for
permission to publish these data. We are also
thankful to the Pathology and Microbiology
departments and ICMR Cytology Centre, M.A.M.
College and various other hospitals for their
contribution in the present stuay.
.
REFERENCES
Danek, S.L and Bower, J.S.: Diagnosis of pulmonary
tuberculosis by flexible fiberoptic tronchoscopy.Am.
Rev. Resp. Dis. 1979; 119 : 677-679.
Funahashi, A; Lohaus, G.H.; Politis, J and Hranicka, L.J. :
Role of fiberoptic bronchoscopy in the diagnosis of
mycobacterial diseases. Thorax. 1983;38 : 267-270.
Jain, N.K.; Sharma, J.N.; Menon, A; Aggarwal, K; Koolwal,
S; Sarkar, S.K. and Purohit, S.D. : Low lung field
tuberculosis : An evaluation of broncho-fiberoscopy in
bacteriological diagnosis. Ind. J. Chest Dis. and All.
Sci. 1984; 26 : 20-24.
James, R.J.; Denis ; A.C, and David, E.D.: The value of
bronchoscopy in the diagnosis of mycobacterial disease.
A five year experience. Chest. 1981; 80:
575-578.
Kato, H; Fukuhara, I; Mashimo, K : Transbronchial
bacteriological culture study using flexible fiberoptb
bronchoscope. A bacteriological study of lidocaine
solution. Journal of Japanese Broncho-Esophageal
Society. 1978; 29 : 13-20.
Kulpati, D.D. and Adarsh Kumar: Flexible fiberoptic
bronchoscopy in lower respiratory tract infections. Ind. J.
Chest Dis. and All. Sci. 1980; 22 : 39
Kvale, P.A.; Johnson, M.C, and Wroblewski, D.A. :
Diagnosis of tuberculosis, routine cultures of bronchial
washings are not indicated. Chest. 1979; 76 : 140-142.
Puorhit, S.D.; Sisodia, R.S.; Gupta, P.R. et al. :
Fiberoptic bronchoscopy in diagnosis of smear negative
pulmonary tuberculosis. Lung India 1983; 1 : 143-146.
Sarkar, S.K; Sharma, G.S.; Gupta, P.R. and Sharma, RK :
Fiberoptic bronchoscopy in the diagnosis of pulmonary
tuberculosis. Tubercle. 1980; 61 : 97-99.
Uddenfeldt, M and Lundgren, R : Flexible fiberoptic
bronchoscopy in the diagnosis of pulmonary tuberculosis.
Tubercle. 1981; 62 : 197-199.
Wallace, J.M.; Dautsch, A.L.; Harrell, J.H. and Moser, KM :
Bronchoscopy and transbronchial biopsy in evaluation of
patients with suspected active tuberculosis. Am. J. Med.
1981; 70 : 1189-1194.