Application of High-Frequency Oscillation during Bronchoscopy in Smear-Negative Pulmonary Tuberculosis

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Viratch Tangsujaritvijit Somcharoen Thienchairoj Detajin Junhasavasdikul Thotsaporn Morasert Dararat Eksombatchai

Abstract

Background: The diagnostic yield of bronchoalveolar lavage (BAL) for diagnosis of pulmonary tuberculosis (PTB) is low. The vibrator device is useful for sputum induction.


Objective: This trial was aimed to assess the value of high-frequency oscillation (HFO) during fiberoptic bronchoscopy (FOB) for diagnosis of patients with suspected PTB.


Methods: Suspected PTB patients with two consecutive negative sputum acid-fast bacilli (AFB) smears were recruited. Patients were chosen to use the HFO device by randomization, while the other patients underwent standard BAL. The BAL fluid and post-bronchoscopic sputum were processed for AFB smear and culture, and polymerase chain reaction for TB (PCR-TB).


Results: Eighty patients participating in this study, PTB was definitely diagnosed in 32 patients. The diagnostic yield of HFO with BAL culture was 27.8%, and non-HFO 21.1% (P = 0.71). The diagnostic yield of HFO with post-bronchoscopic sputum culture was 22.2%, and non-HFO 21.1% (P = 1.00). The diagnostic yield of PCR-TB with HFO was 33.3%, and non-HFO 21.1% (P = 0.47).


Conclusions: Addition of HFO during FOB did not result in significant differences in the diagnostic yield of PTB detection in smear-negative PTB patients. However, there was a trend of increasing sensitivity of BAL PCR-TB in patients receiving HFO.


 


 

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How to Cite
Tangsujaritvijit, V., Thienchairoj, S., Junhasavasdikul, D., Morasert, T., & Eksombatchai, D. (2017). Application of High-Frequency Oscillation during Bronchoscopy in Smear-Negative Pulmonary Tuberculosis. Ramathibodi Medical Journal, 40(2), 25-33. Retrieved from https://www.tci-thaijo.org/index.php/ramajournal/article/view/72202
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Original Articles

References

1. World Health Organization. Treatment of tuberculosis: guidelines for national programmes, 4th ed. Geneva: WHO; 2010.

2. Kvale PA, Johnson MC, Wroblewski DA. Diagnosis of tuberculosis: routine cultures of bronchial washings are not indicated. Chest. 1979;76(2):140-142.

3. Strumpf IJ, Tsang AY, Sayre JW. Re-evaluation of sputum staining for the diagnosis of pulmonary tuberculosis. Am Rev Respir Dis. 1979;119(4):599-602.

4. Wallace JM, Deutsch AL, Harrell JH, Moser KM. Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis. Am J Med. 1981;70(6):1189-94.

5. Chawla R, Pant K, Jaggi OP, Chandrashekhar S, Thukral SS. Fiberoptic bronchoscopy in smear-negative pulmonary tuberculosis. Eur Respir J. 1988;1(9):804-806.

6. Majaestic C, Montgomery M, Jones R, King M. Reduction in sputum viscosity using high frequency chest compressions compared to conventional chest physiotherapy. Pediatr Pulmonol. 1996;13(Suppl):A358.

7. Darbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high-frequency chest wall oscillation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. Phys Ther. 2005;85(12):1278-1289.

8. Arens R, Gozal D, Omlin KJ, et al. Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalized patients with cystic fibrosis. Am J Respir Crit Care Med. 1994;150(4):1154-1157.

9. Yan L, Cui H, Xiao H, Zhang Q. Anergic pulmonary tuberculosis is associated with contraction of the Vd2+T cell population, apoptosis and enhanced inhibitory cytokine production. PLoS One. 2013;8(8):e71245. doi:10.1371/journal.pone.0071245.

10. Yang CJ, Chen TC, Hung JY, et al. Routine culture for Mycobacterium tuberculosis from bronchoscopy in Taiwan. Respirology. 2007;12(3):412-415.

11. Baughman RP. Technical aspects of bronchoalveolar lavage: recommendations for a standard procedure. Semin Respir Crit Care Med. 2007;28(5):475-485.

12. Baughman RP, Spencer RE, Kleykamp BO, Rashkin MC, Douthit MM. Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield. Eur Respir J. 2000;16(6):1152-1157.

13. De Brauwer EI, Jacobs JA, Nieman F, Bruggeman CA, Drent M. Bronchoalveolar lavage fluid differential cell count: how many cells should be counted? Anal Quant Cytol Histol. 2002;24
(6):337-341.

14. Kennedy DJ, Lewis WP, Barnes PF. Yield of bronchoscopy for the diagnosis of tuberculosis in patients with human immunodeficiency virus infection. Chest. 1992;102(4):1040-1044.

15. Vijayan VK. Role of BAL in the diagnosis and immunological evaluation of patients with pulmonary tuberculosis. Ind J Tub. 2000;47:73-78.

16. Baughman RP, Dohn MN, Loudon RG, Frame PT. Bronchoscopy with bronchoalveolar lavage in tuberculosis and fungal infections. Chest. 1991;99(1):92-97.

17. Charoenratanakul S, Dejsomritrutai W, Chaiprasert A. Diagnostic role of fiberoptic bronchoscopy in suspected smear negative pulmonary tuberculosis. Respir Med. 1995;89(9):621-623.

18. Malekmohammad M, Marjani M, Tabarsi P, et al. Diagnostic yield of post-bronchoscopy sputum smear in pulmonary tuberculosis. Scand J Infect Dis. 2012;44(5):369-373. doi:10.3109/00365548.2011.643820.

19. Conte BA, Laforet EG. The role of the topical anesthetic agent in modifying bacteriologic data obtained by bronchoscopy. N Engl J Med. 1962;267:957-960.

20. Liam CK, Chen YC, Yap SF, Srinivas P, Poi PJ. Detection of Mycobacterium tuberculosis in bronchoalveolar lavage from patients with sputum smear-negative pulmonary tuberculosis using a polymerase chain reaction assay. Respirology. 1998;3(2):125-129.

21. Müller NL, Franquet T, Lee KS, Silva CIS. Imaging of pulmonary infections. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

22. Collins J, Stern EJ. Chest radiology: The Essentials. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

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