Adesh Kumar et al. Flexible Fiberoptic Bronchoscopy in Suspected Sputum Smear Negative Pulmonary Tuberculosis 31 International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 1 ROLE OF FLEXIBLE FIBEROPTIC BRONCHOSCOPY IN SUSPECTED SPUTUM SMEAR NEGATIVE PULMONARY TUBERCULOSIS CASES AT MICROSCOPY CENTRE UNDER RNTCP Adesh Kumar 1 , Ashish Gupta 1 , Mohd. Haroon Khan 2 1 Department of Pulmonary Medicine UP Rural Institute of Medical Science & Research, Saifai Etawah, Uttar Pradesh, India 2 Department of Community Medicine, Rohilkhand Medical College & Hospital, Bareilly, Uttar Pradesh, India Correspondence to: Mohd. Haroon Khan (drharoonkhan99@yahoo.com) DOI: 10.5455/ijmsph.2013.200920133 Received Date: 07.09.2013 Accepted Date: 16.01.2014 ABSTRACT Background: Microbiological diagnosis is the main stay for the effective treatment of pulmonary tuberculosis. About 31%of the new cases may be smear-negative for AFB. Difficulties arise when a patient who is suspected of active tuberculosis, both clinically and radiologically, does not produce sputum or when it is available AFB may be negative. Fiberoptic bronchoscopy offers a mean of investigation whereby bronchial secretion and washing can be collected from the most likely abnormal site under direct vision. Aims & Objective: To study the role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP. Material and Methods: Thirty three patients aged Above 18 years old who were suspected of having pulmonary tuberculosis based on clinical and radiological appearances were prospectively studied. All subjects had at least 2 sputum smear examination which were negative for acid fast bacilli according to the revised national tuberculosis control program (RNTCP). The bronchoscopy was performed transnasally using fujinon bronchoscope by 2 bronchoscopists under local anaesthesia. A thorough examination of bronchial tree was carried out and bronchial aspirate (BA) bronchoalveolar lavage (BAL) bronchial brushing, transbronchial lung biopsy (TBLB) and post bronchoscopy sputum (PBS) were collected. The specimen obtained was placed on slides for Ziehl-Nielsen stain. Bronchial biopsy was performed on abnormal looking mucosa and stained with Eiosin-hematoxylin and Ziehl- Nielsen stains. Results: In total 33 sputum smear negative suspected pulmonary tuberculosis cases, at microscopy centre under RNTCP, early diagnosis of pulmonary tuberculosis was established in 10 (30.30%) cases and in 3 (9.09%) cases diagnosis of malignancy was established. Conclusion: Fiberoptic Bronchoscopy is a useful procedure to establish the diagnosis of pulmonary tuberculosis when sputum smear examination does not show acid fast bacilli. This allows appropriate treatment to be started with confidence. Key-Words: Pulmonary Tuberculosis; Fiberoptic Bronchoscopy; Bronchoalveolar Lavage; Ziehl-Nielsen Stain; RNTCP Introduction Microbiological diagnosis is the main stay for the effective treatment of pulmonary tuberculosis for obtaining the correct sputum sample, patient education is imperative. However, even if the correct sample is expectorated, the bacillary population has to be at least 10000 per millilitre, to get the smear positive for acid fast bacilli (AFB). [1] Moreover, it depends on the previous treatment, default behaviour, and effective cough. Again 31%of the new cases may be smear-negative for AFB. [2] Difficulties arise when a patient who is suspected of active tuberculosis, both clinically and radiologically, does not produce sputum. Harris et al found that 40-60% of patient with active pulmonary tuberculosis suspected clinically or radiologically may fail to produce sputum, or when it is available AFB may be negative. [3] This poses problem to the clinicians who often have to embark on empirical anti- tuberculous treatment if clinical suspicion is high, at the same time subjecting patient to potentially toxic drugs and the inconveniences of prolonged therapy. A number of studies confirm the usefulness of fiberoptic bronchoscopy in diagnosis of pulmonary tuberculosis. Chan HS, et al analysed the ability to make a definitive diagnosis in sputum smear negative pulmonary tuberculosis by bronchoscopic aspiration; bronchoalveolar lavage (BAL) and examination of post-bronchoscopy sputum were compared. 34 patients with lesions on chest X-ray suspected of being pulmonary tuberculosis were entered into the study. A positive AFB smear result was obtained in 4/28 (14%) of cases by a combination of bronchoscopic techniques and post bronchoscopy sputum examination. Sputum examination, bronchoscopic aspiration and BAL are complementary techniques and together they give a high yield of definitive diagnosis of pulmonary tuberculosis. [4] Fiberoptic bronchoscopy offers a mean of investigation whereby bronchial secretion and washing can be collected from the most likely abnormal site under direct vision. This study was carried out to know the usefulness of bronchoscopy in sputum smear negative pulmonary tuberculosis patient diagnosed on clinically and radiologically grounds, by direct visualization of bronchial tree and collecting specimens such as bronchial aspirate, bronchoalveolar lavage and postbronchoscopy sputum and RESEARCH ARTICLE