الفهرس 
PULMONARY TUBERCULOSISOnly 14 pages are availabe for public view
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Abstract
Adisease caused by Mycobacterium, known as Tuberculosis (TB) is a global health problem, in developing countries. The widely available medical therapy has a high cure rate but the main issue with TB is the need for the rapid diagnostic test with high accuracy to commence an early treatment.
One-third of tuberculosis cases are sputum negative or scarce. These cases are infectious and early diagnosis and treatment initiation requires good quality specimen. Flexible bronchoscopy presents as an effective tool in diagnosis of sputum scarce and sputum negative patients. Various techniques include bronchoalveolar lavage, bronchial washings, various biopsy techniques such as biopsies of endobronchial TB cases, and in cases of lymphadenopathy.
The diagnosis can be done by smear AFB microscopy and cultures. The combination of these increase diagnostic yield in tuberculosis. Xpert® MTB/RIF assay (Cepheid, USA) can be performed on the specimen yielded by various bronchoscopy techniques. It is the only rapid molecular test for diagnosis of MTB which has been recommended by WHO since 2010, and it is also the only fully automated cartridge-based real-time DNA-based test that can detect both TB and resistance to rifampicin. The results can be obtained as early as 2 hours which is in sharp contrast to 6-8 weeks required for culture-based diagnosis which is considered “gold standard”.
This current analytical cross-sectional study carried out in bronchoscopy unit at Abbasiya chest hospital from November 2019 to August 2020. It included 50 adult patients with suspected pulmonary tuberculosis on clinical or radiological grounds. Thirty patients’ data were collected prospectively and twenty patients’ data were collected retrospectively from hospital records in the time line from January 2019 to November 2019. The research protocol was submitted for ethical review of the Institutional Review Board (IRB) of Ain Shams University, Faculty of Medicine. All potential patients signed written informed consent and permission from hospital ethical committee was granted.
• Demographic data: 50 patients were included in our study, 28 (56%) were males and 22 (44%) were females. The mean age was 37.12 ± 11.90 years.
• Comorbidities: Diabetes was the most common comorbidity as it counted (28.6) of all patients followed by cardiovascular diseases.
• Clinical manifestation: The most common complaints of the patient were fever (98%) followed by cough (94%).
• Radiological finding: the most common radiological findings were cavitation followed by consolidation.
• The smear AFB was negative in 33 samples out of 50 samples.
• There was a statistically significant difference between BAL GeneXpert and smear AFB.
• Comparison between BAL Lowenstein-Jensen (LJ) culture and BAL GeneXpert in diagnosis of TB showed no statistical difference.
• There was statistical difference between smear AFB and BAL L.J culture.