Improving Diagnostic of Pulmonary Tuberculosis in HIV Patients by Bronchoscopy: A Cross Sectional Study
Abstract: diagnostic of
pulmonary TB in HIV patients is a problem due to non specific clinical
features, or radiological appearance. HIV patients with CD4≤200 cells/mL
infected with M. tuberculosis have less capacity in containing M. tuberculosis,
developing granulomas, casseous necrosis, or cavities. This condition is caused
by weakend inflammatory which later reduced sputum production and may cause
false negative result. This study aimed to assess differences in the positivity
level of acid fast bacilli (AFB) and cultures of M. tuberculosis from
non-bronchoscopic sputum (spontaneous and induced sputum) compared to
bronchoscopic sputum (bronchoalveolar lavage) in HIV positive patients
suspected pulmonary tuberculosis with CD4<200 cells/μL.
Methods: this cross sectional study was conducted in adult HIV patients
treated in Hasan Sadikin Hospital with CD4≤200 cells/μL suspected with
pulmonary tuberculosis by using paired comparative analytic test. All patients
expelled sputum spontaneously or with sputum induction on the first day. On the
next day, bronchoalveolar lavage (BAL) was performed. The two samples obtained
from two methods were examined by AFB examination with staining Ziehl Neelsen
(ZN) and cultured of M. tuberculosis on solid media Ogawa on all patients. Positivity,
sensitivity and increased sensitivity of AFB and culture of M. tuberculosis in
the non bronchoscopic and bronchoscopic groups were compared.
Results: there were differences in the positivity level of AFB with ZN
staining between non-bronchoscopic and bronchoscopic groups which were 7/40
(17.5%) vs 20/40 (50.0%) (p<0.001). The differences between the cultures of
non-bronchoscopic and bronchoscopic groups were 16/40 (40.0%) vs 23/40 (57.5%)
(p=0.039). Bronchoscopic sputum increased the positivity level of the ZN AFB
examination by 32.5% (from 17.5% to 50.0%) as well as on culture examination by
17.5% (from 40.0% to 57.5%).
Conclusion: Bronchoalveolar lavage can improve the positivity level of
smears and cultures in patients suspected of pulmonary TB in HIV patients with
CD4<200 cells/μL.
Keywords: bronchoscopy; HIV;
microbiological diagnostics; sputum; tuberculos
Author: Prayudi Santoso, Arto
Y Soeroto, Rianita Juniati, Yovita Hartantri, Rudi Wisaksana, Bachti
Alisjabana, Heda M Nataprawira, Ida Parwati
Journal Code: jpkedokterangg170368
