Detection of Mycobacterium tuberculosis in bronchoalveolar lavage from patients with sputum smear‐negative pulmonary tuberculosis using a polymerase chain reaction assay

Abstract

The objective of this study was to evaluate the utility of a polymerase chain reaction (PCR) assay in detecting Mycobacterium tuberculosis in bronchoalveolar lavage (BAL) specimens of patients suspected of having active pulmonary tuberculosis (TB) but who were sputum smear-negative. Patients undergoing investigation for suspected pulmonary TB at the University Hospital, Kuala Lumpur, and who were sputum smear-negative underwent fibreoptic bronchoscopy and BAL. One portion of each lavage specimen was submitted for smear examination for acid-fast bacilli and mycobacterial culture and the other portion assayed by PCR for the presence of a 562-base pair DNA segment belonging to the insertion sequence IS986, unique to the M. tuberculosis complex. As controls, lavage specimens from patients with other lung lesions were also similarly tested. The PCR assay gave a positivity rate of 80.9% (55 of 68) compared with 8.8% of smear examination and 7.4% of culture for detecting M. tuberculosis in BAL specimens. The assay was positive in two of 45 BAL specimens from 35 control subjects. The PCR assay was more sensitive than smear and culture in detecting M. tuberculosis in BAL specimens of patients with sputum smear-negative pulmonary TB.

Assessment by Meta-Analysis of PCR for Diagnosis of Smear-Negative Pulmonary Tuberculosis

“…This finding supports previous recommendations to use bronchial specimens in suspected cases of SPT (36). Because many of the studies that included bronchial specimens also evaluated sputum specimens, the difference between these studies and those that assessed only sputum specimens was probably underestimated.…”

Antemortem Diagnosis of Mycobacterium bovis Infection in Free-ranging African Lions (Panthera leo) and Implications for Transmission

“…In our study, lions 2 and 3 (Table 1) were pride mates, suggesting either intraspecies transmission or a common infectious source. Bronchoalveolar lavage (BAL) samples are reported to be more sensitive than sputum samples for detection of mycobacteria in human patients with known culture-positive tuberculosis (TB) (Liam et al 1998;Tueller et al 2005). In one study, only 39% of known TB cases had positive sputum smears compared with 83% detection by either positive smear or PCR using BAL fluid (Tueller et al 2005).…”

“…In one study, only 39% of known TB cases had positive sputum smears compared with 83% detection by either positive smear or PCR using BAL fluid (Tueller et al 2005). Bronchoalveolar lavage can also increase detection of M. tuberculosis in sputumnegative human patients (Liam et al 1998). Previous studies in lions have inferred infection status based on TST results, postmortem pathologic changes, or confirmed infection by culture of tissues (Keet et al 2010).…”

Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis

“…After a systematic literature search and selection, a total of nine studies with 1214 subjects were included in this meta-analysis [15][16][17][18][19][20][21][22][23]. The article selection process used in the present study is summarized in Figure 1.…”

“…There were 357 patients with SNPT and 857 controls. Seven studies performed in Asia [15][16][17][19][20][21][22] and two studies performed in Europe [18,23]. All studies provided the detailed diagnostic criteria for SNPT, including bacteriology, histopathology or clinical diagnosis, which was widely accepted in Flow chart of selection process for eligible articles studies with tuberculosis diagnosis.…”