Abstract :
Introduction : Tuberculosis is a global health burden still causing large mortality and morbidity. According
to WHO’s 2018 Global TB Report two main routes for reducing TB incidence and death are- diagnosis and
treatment. The main challenging issue with TB is to obtain a rapid and accurate diagnosis for initiating
early treatment. Sometimes patient with active pulmonary tuberculosis fail to produce adequate sputum
resulting in increase of false-negatives. Sputum-smear negative pulmonary tuberculosis is highly infectious
and remains a diagnostic challenge. Fiber-optic bronchoscopy is an important tool for early detection
and confirmation of sputum smear-negative and sputum-scarce PTB as it provides high-quality biological
samples like bronchoalveolar lavage (BAL) fluid. The aim of the present study was to evaluate role of in
Gene Xpert MTB/RIF on bronchoscopic specimens in sputum smear negative patients with suspicion of
PTB.
Materials and Method: A prospective observational study was done on 100 patients with clinical suspicion
of PTB who either have a negative sputum smear microscopy or unable to produce qualitative sputum
attending outpatient and admitted in Pulmonology department, Government General Hospital, Kakinada.
Results: Out of 100 patients, 47 were diagnosed and confirmed as pulmonary tuberculosis of which
bronchial specimens smear positive were 5(10.6%),bronchial specimens smear negative but CBNAAT
positive were 42(89.3%). At last as CBNAAT has dual diagnostic advantage of detecting rifampicin
resistance, about 5 cases were detected as rifampicin resistance.
Conclusions: CBNAAT/RIF assay on BAL specimen provides an accurate diagnosis of PTB in patients
with sputum smear negative results or those who cannot expectorate sputum and superior to sputum smears
in detecting rifampicin resistance.
Keyword :
Bronchoscopy, BAL, Gene Xpert, CBNAAT.