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Chest Infections |

Diagnostic Yield in Detecting Pulmonary Tuberculosis During Inpatient Hospitalization: Sputum Versus BAL Culture Analysis

Raminderjit Sekhon, MD; Jacob Mathew, MD; Zeron Ghazarian, MD; M Khan, MD
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St. Joseph's Regional Medical Center, Paterson, NJ


Chest. 2015;148(4_MeetingAbstracts):132A. doi:10.1378/chest.2281080
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Abstract

SESSION TITLE: Chest Infections Posters: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: In-patient hospitalization for suspected pulmonary tuberculosis (PTB) can often present a challenge to the clinician. Obtaining objective evidence of mycobacterial culture can result in a potential delay in both the diagnosis and initiation of treatment. Sputum analysis has been the gold standard in diagnosing PTB, with greater diagnostic yield obtained by the patient providing three consecutive morning samples. Other methodology to diagnose PTB may include bronchoalveolar lavage (BAL) in patients unable to provide adequate sputum. In light of the above, we aim to demonstrate that sputum provides an adequate means of diagnosing PTB over more invasive maneuvers, specifically bronchoscopy.

METHODS: We performed a retrospective analysis of in-patient admissions at a tertiary care hospital for suspected PTB from January 2005 to January 2014. Charts of patients were identified in whom PTB was suspected, and from whom sputum samples were collected and bronchoscopy with BAL performed.

RESULTS: A total of 31 patients had undergone bronchoscopy with BAL and collection of three sputa examined for mycobacterium. Of the 31 patients, 5 patients (16%) had positive identification in both BAL and sputa cultures, 4 patients (13%) with sputa only positivity, while no patients were identified with only BAL positive cultures. The remainder of the patients had no positive cultures. A statistically significant difference was noted regarding confirmation of mycobacterium positivity with sputum over BAL (p=0.04).

CONCLUSIONS: Pulmonary tuberculosis can be a diagnostic challenge when obtaining positive identification of mycobacteria culture during in-hospital admissions. Conventional analysis obtained by sputum smear and culture can help identify patients. Other modalities, specifically BAL, can also be utilized in select situations. Our results reflect that BAL culture obtained is not superior in detecting culture positive TB over sputum analysis. As such, additional testing with bronchoscopy may delay diagnosis and treatment in patients who are capable of providing adequate sputum.

CLINICAL IMPLICATIONS: Our results help reaffirm the diagnostic superiority of sputum smear and culture analysis for the detection of PTB. While BAL can help provide adequate sampling for culture in patients who are not able to provide sputum, it may be an unnecessary test. Regardless, physicians should not delay starting treatment while awaiting analysis of sputum. .

DISCLOSURE: The following authors have nothing to disclose: Raminderjit Sekhon, Jacob Mathew, Zeron Ghazarian, M Khan

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