Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

Abstract

Objective: To evaluate the diagnostic accuracy of bronchoscopy in patients with clinical or radiological suspicion of tuberculosis who were unable to produce sputum or with negative sputum smear microscopy results. Methods: A prospective cross-sectional study involving 286 patients under clinical or radiological suspicion of having pulmonary tuberculosis and submitted to bronchoscopy-BAL and transbronchial biopsy (TBB). The BAL specimens were submitted to direct testing and culture for AFB and fungi, whereas the TBB specimens were submitted to histopathological examination. Results: Of the 286 patients studied, 225 (79%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 127 (44%); nonspecific chronic inflammation, in 51 (18%); pneumocystis, fungal infections, or nocardiosis, in 20 (7%); bronchiolitis obliterans organizing pneumonia, alveolites, or pneumoconiosis, in 14 (5%); lung or metastatic neoplasms, in 7 (2%); and nontuberculous mycobacterium infections, in 6 (2%). For the diagnosis of tuberculosis, BAL showed a sensitivity and a specificity of 60% and 100%, respectively. Adding the TBB findings significantly increased this sensitivity (to 84%), as did adding the post-bronchoscopy sputum smear microscopy results (total sensitivity, 94%). Minor post-procedure complications occurred in 5.6% of the cases. Conclusions: Bronchoscopy is a reliable method for the diagnosis of pulmonary tuberculosis, with low complication rates. The combination of TBB and BAL increases the sensitivity of the method and facilitates the differential diagnosis with other diseases.Keywords: Bronchoscopy; Tuberculosis, pulmonary; Sputum; Bronchoalveolar lavage; Biopsy. ResumoObjetivo: Avaliar a acurácia diagnóstica da broncoscopia em pacientes com suspeita clínica ou radiológica de tuberculose, com baciloscopia negativa ou incapazes de produzir escarro. Métodos: Estudo transversal prospectivo de 286 pacientes com suspeita clínica/radiológica de tuberculose pulmonar e submetidos à broncoscopia -LBA e biópsia transbrônquica (BTB). As amostras de LBA foram testadas por pesquisas diretas e culturas de BAAR e de fungos, e as de BTB por exame histopatológico. Resultados: Dos 286 pacientes estudados, a broncoscopia contribuiu para o diagnóstico em 225 (79%): tuberculose pulmonar em 127 (44%); inflamações crônicas inespecíficas em 51 (18%); pneumocistose, infecções fúngicas ou nocardiose em 20 (7%); bronquiolite obliterante com pneumonia em organização, alveolites ou pneumoconioses em 14 (5%); neoplasias pulmonares ou metastáticas em 7 (2%); e micobacterioses não tuberculosas em 6 (2%). Para o diagnóstico de tuberculose, o LBA mostrou sensibilidade e especificidade de 60% e 100% respectivamente, havendo um aumento importante da sensibilidade quando associado à biópsia (84%) e à baciloscopia após a broncoscopia (94%). Complicações controláveis decorrentes do procedimento ocorreram em 5,6% dos casos. Conclusões: A broncoscopia representa um método diagnóstico confiável para pacientes com tubercu...

Bronchoscopic findings of flexible bronchoscopy: a one-year retrospective study in a tertiary care hospital

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Do que morrem os pacientes com tuberculose: causas múltiplas de morte de uma coorte de casos notificados e uma proposta de investigação de causas presumíveis

“…gov.br/DATASUS/index.php, acessado em 15/ Jul/2013). Os sinais e sintomas evidentes podem confundir o diagnóstico, até mesmo com imagens radiológicas compatíveis 15 . Por isso, exames bacteriológicos, como a baciloscopia e a cultura, acopladas ou não à broncoscopia ou à biopsia, são exames que devem ser utilizados para a confirmação diagnóstica.…”

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

“…In Brazil, Jacomelli and co-workers [52] investigated 286 patients with clinical or radiological suspicion of TB who were unable to produce sputum or had a negative smear. They found that 7% of infections were caused by Pneumocystis , fungi and Nocardia .…”