IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 6 Ser. 8 (June. 2019), PP 01-06 www.iosrjournals.org DOI: 10.9790/0853-1806080106 www.iosrjournals.org 1 | Page Yield of Brochoalveolar Lavage in Clinico Radiologically Suspected Cases of Sputum Smear Negative Pulmonary Tuberculosis Dr. Debabrata Saha 1 , Dr. Sudipta Pandit 1 , *Dr. Sabyasachi Choudhury 1 , Dr. Subhajit Ghosh 2 (1 Department of Respiratory Medicine, Medical College, Kolkata, India; 2 Cipla Respiratory) Corresponding Author: *Dr. Sabyasachi Choudhury Abstract: Tuberculosis (TB) is a major public health problem in India. Diagnosis of active Pulmonary TB (PTB) is often delayed due to Acid-fast bacilli (AFB) smears of respiratory specimens (at least two or more specimens) are necessary for the prompt diagnosis of PTB, but AFB smears has poor sensitivity (30-70%) despite high specificity (98-99%). Mycobacterial culture are more sensitive than AFB smears (80-85%), but culture results usually require 3-8 weeks. Every attempt to establish a definitive diagnosis of tuberculosis should be made in patients who are either unable to produce sputum voluntarily or are smear negative by conventionally obtained sputum sample. Fibreoptic bronchoscopy guided bronchalveolar lavage is a relatively safe and useful procedure for diagnosis of suspected cases of pulmonary tuberculosis when smears of expectorated sputum do not reveal mycobacterium. The study was conducted in the department of chest medicine of Medical College, Kolkata from January 2017 to March 2017. Patients attending TB clinic under department of chest medicine were randomly selected and a total of 70 patients were recruited. On examination of BAL fluid, 17.1% found to be AFB smear positive on Ziehl-Neelsen staining and upon BACTEC culture, 25.7% showed positive growth of Mycobacterium Tuberculosis. This showed that Bronchoalveolar lavage can be a viable tool to confirm the diagnosis of sputum smear negative cases for diagnosis and treatment of Pulmonary Tuberculosis. Key Words: Pulmonary Tuberculosis (PTB), Fibreoptic bronchoscopy, Bronchoalveolar lavage (BAL), Smear negative. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 29-05-2019 Date of acceptance: 15-06-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Tuberculosis (TB) is a major public health concern in India. India accounts for one fourth of the global Tuberculosis burden. In 2015, an estimated 28 lakh cases occurred and 4.8 lakh people died due to TB [1]. The global strategy to control TB is prompt diagnosis, notification and successful treatment of patients with active, transmissible disease. Early diagnosis of active Pulmonary Tuberculosis (PTB) is critical for control of TB. Unfortunately, diagnosis of active PTB is often delayed due to less than half of these patients have a positive sputum smear (23-29% in 2009 in Korea) and isolation of Mycobacterium Tuberculosis (MTB) takes a long time [2,3,4]. Acid-fast bacilli (AFB) smears of respiratory specimens (at least two or more specimens) are necessary for the prompt diagnosis of PTB, but AFB smears has poor sensitivity (30-70%) despite high specificity (98-99%). Mycobacterial culture are more sensitive than AFB smears (80-85%), but culture results usually require 3-8 weeks [5]. The diagnosis of TB and decision to start treatment of sputum smear negative TB is usually dependent upon clinical features, but 20% of PTB patients are completely asymptomatic whereas 42-86% of PTB patients may be symptomatic. Sputum smear negative PTB patients are especially likely to show no or mild respiratory symptoms and systemic manifestations [6]. Murray et al. found that in the pre-AIDS (Acquired Immunodeficiency Syndrome) era, there were 1.22 cases of smear negative PTB for every case of smear positive PTB [7]. After that, a study from western Canada by Long et al. found that for every smear positive PTB case there were 2.52 smear negative PTB and extra-pulmonary cases [8]. The association of AFB negative smear along with lesser number of bacilli and minimal non-cavitary radiographic patterns might imply that smear negative cases are less infectious. However a DNA finger printing study from San Francisco attributed 17% of TB transmission to smear negative, culture positive tuberculosis cases [9]. Therefore every attempt to establish a definitive diagnosis of tuberculosis should be made in patients who are either unable to produce sputum voluntarily or are smear negative by conventionally obtained sputum sample. World Health Organization (WHO) recommends detection of acid-fast bacilli in respiratory specimens