Abstract

We aimed to assess whether acid-fast bacilli (AFB) determination in gastric lavage (GL) and bronchial lavage (BL) contributes to evaluation of cases radiologically suggestive of pulmonary tuberculosis but with negative AFB in sputum or unable to expectorate sputum.

Although 168 cases were enrolled into the study, at the end, 22 cases were excluded because they were evaluated as having inactive tuberculosis or a disease other than tuberculosis. The remaining 146 cases were evaluated in 3 groups. Group A consisted of 49 patients that could not expectorate sputum and in these patients only GL was obtained. In group B, AFB was negative in sputum and only BL was performed in these 58 patients. In group C, there were 39 patients that were unable to expectorate sputum and negative for AFB in GL, additionally BL was performed in these patients. Smear positivity was 30/49 (61.2%) and culture positivity was 15/49 (30.6%) in group A patients. In-group B, smear positivity was 30/58 (51.7%) and culture positivity was 47/58 (81.0%). In-group C, BL smear positivity and culture positivity were 6/39 (15.4%) and 21/39 (53.8%) respectively and GL culture positivity was 13/39 (33.3%). Thirteen cases in whom AFB could not be detected microbiologically but who were strongly suggestive of tuberculosis radiologically, were regarded as tuberculosis according to ‘from treatment to diagnosis’ criteria. Detection of AFB culture positivity in diagnosis of tuberculosis is important in terms of early initiation of treatment and detection of resistant bacilli. Therefore we suggest that in cases that are unable to expectorate sputum, obtaining GL and in cases with negative sputum smear, performing BL would be helpful.