Abstract
Recent studies have reported that a relative increase in primary adult tuberculosis in advanced nations has produced unusual clinical and roentgenographic presentations because of the complex interaction of a variety of factors involving the host, environment, and infectious agents. To assess the value of fiberoptic bronchoscopy and transbronchial biopsy (FBS/TBB) for evaluating patients who had active tuberculosis, we reviewed the records of 27 tuberculous patients diagnosed by FBS/TBB among 1527 cases who underwent fiberoptic bronchoscopy at Yamagata Prefectural Central Hospital from January 1982-September 1987. The evaluations included cases of fiberoptic bronchoscopoy with aspirations of bronchial secretions and washing fluid, and TBB. All aspirated bronchial secretions and washing fluid were always stained and cultured for Mycobacteria in our hospital. All patients in this study had an absense of acid-fast bacilli on prebronchoscopy sputum smears or an inability to produce sputum. Only 6 of 27 patients (22.2%) were suspected of having tuberculosis and 11 of 27 (40.7%) were suspected of lung cancer before fiberoptic bronchoscopy. Immediate diagnoses were made from microscopic specimens obtained from 21 of 27 (77.7%) FBS/TBB procedures. TBB had the best yield for microscopic diagnosis. In 6 of 27 patients delayed diagnoses were made because of negative microscopic specimens which become positive only on culture. The most frequent roentogenographic change was consolidation, which was found in 12 patients. Cases with positive smears of bronchial secretions had wider consolidation fields than cases with positive TBB specimens. Only 5 (18.5%) had cavitary lesions. Endobronchial involvement was found in 12 of 27 patient who underwent FBS. The abnormal bronchoscopic findings included ulcerative granuloma (2 patients), and redness and swelling of the mucosa (10). In conclusion, tuberculosis should be considered as a diagnostic possibility in patients even with negative sputum smears. FBS/TBB can improve the ability to document active tuberculosis and provide a sensitive means of making immediate diagnosis.
