Role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP

Background: 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 or when it is available AFB may be negative. Fiberoptic bronchoscopy offers a mean of investigation whereby bronchial secretion and washing can be collected from the most likely abnormal site under direct vision. Aims & Objective: To study the role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP. Material and Methods: Thirty three patients aged Above 18 years old who were suspected of having pulmonary tuberculosis based on clinical and radiological appearances were prospectively studied. All subjects had at least 2 sputum smear examination which were negative for acid fast bacilli according to the revised national tuberculosis control program (RNTCP). The bronchoscopy was performed transnasally using fujinon bronchoscope by 2 bronchoscopists under local anaesthesia. A thorough examination of bronchial tree was carried out and bronchial aspirate (BA) bronchoalveolar lavage (BAL) bronchial brushing, transbronchial lung biopsy (TBLB) and post bronchoscopy sputum (PBS) were collected. The specimen obtained was placed on slides for Ziehl-Nielsen stain. Bronchial biopsy was performed on abnormal looking mucosa and stained with Eiosin-hematoxylin and Ziehl- Nielsen stains. Results: In total 33 sputum smear negative suspected pulmonary tuberculosis cases, at microscopy centre under RNTCP, early diagnosis of pulmonary tuberculosis was established in 10 (30.30%) cases and in 3 (9.09%) cases diagnosis of malignancy was established. Conclusion: Fiberoptic Bronchoscopy is a useful procedure to establish the diagnosis of pulmonary tuberculosis when sputum smear examination does not show acid fast bacilli. This allows appropriate treatment to be started with confidence.