Médecine pulmonaire et respiratoire

Comparison of Induced Sputum and Fibre-Optic Bronchoscopy (Fob) in the Early Diagnosis of Sputum Smear Negative Suspected Cases of Pulmonary Tuberculosis under Rntcp Settings-A Study Conducted in Southern Part of Rajasthan

Abstract

Atul Luhadia, Mayank Kapur, Shanti Kumar Luhadia, Rishi Kumar Sharma, Gaurav Chhabra and Shubhkaran Sharma

Background: FOB is an invasive procedure. It is costly, and is not widely available in the developing countries. In resource poor settings, where transmission of TB is high, sputum induction with hypertonic saline can be useful in adding to the diagnostic yield.

Materials and Methods: A prospective study conducted from 2015 to 2016, comprising of 100 patients fulfilling study criteria. Patients with respiratory symptoms and CXR showing suspicious of pulmonary tuberculosis and in whom two sputum smear samples ( Morning and Spot) were negative for acid fast bacilli were included and at randomly divided into 2 groups of induced sputum and bronchoscopy. Sputum induction was done by using 3 ml of 3% hypertonic saline through nebulizer and bronchoscopy was performed under local anesthesia.

Results: Out of 100 patients, 60 were in induced sputum group and 40 in bronchoscopy group. Induced sputum smear examination detected acid fast bacilli in 27 patients (45%) and acid fast bacilli detected from BAL in 26 patients (65%). Though the diagnostic yield with induced sputum was inferior to FOB, but looking to the cost effectiveness, safety and practical applicability of induced sputum, it can be used in patients of all age groups, new and retreatment suspected cases of initial sputum negative pulmonary tuberculosis for the diagnosis even at peripheral health centers.