Fluorescent microscopy and Ziehl–Neelsen staining of bronchoalveolar lavage, bronchial washings, bronchoscopic brushing and post bronchoscopic sputum along with cytological examination in cases of suspected tuberculosis.
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Date
2015-10
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Abstract
Objectives: Ever since the discovery of Mycobacterium tuberculosis in 1882,
many diagnostic methods have been developed. However “The gold standard”
for the diagnosis of tuberculosis (TB) is still the demonstration of acid fast
Bacilli (AFB) by microscopic examination of smear or bacteriological confirmation
by culture method. Materials and Methods: In suspected 75 patients with active
pulmonary TB, the materials obtained bronchoscopically, were bronchoalveolar
lavage (BAL), bronchial brushings, bronchial washings and post bronchoscopic
sputum. Four smears were made from each of the specimen. Fluorescent Staining,
Ziehl–Neelsen (ZN), Pap and May Grunwald‑Giemsa (MGG) stains were carried
out for cytological examination. Results: Fluorescent stain yielded maximum AFB
positivity in all the methods, that is 36 (48%) in post fibre‑optic bronchoscopy (FOB)
sputum and 19 (25.33%) by fluorescence microscopy in both bronchial brushings
and bronchial washings. Maximum yield of AFB with ZN staining 12 (16%) was
equal to the post FOB sputum and bronchial brushings samples. It was followed
by 6 cases (8%) in BAL and 4 (5.3%) in bronchial washings. The cytological
examination was suggestive of TB in only 8 (10.66%) cases in bronchial washings
and 6 (8%) cases in post FOB collection. It was equal in BAL and Bronchial
brushings each that is 5 (6.67%). Conclusion: Bronchoscopy is a useful diagnostic
tool and fluorescent microscopy is more sensitive than ZN and cytology. On X‑ray
examination, other diseases like malignancy or fungus can also mimick TB. So
apart from ZN staining or fluorescence microscopy, Pap and MGG stain will be
worthwhile to identify other microorganisms.
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Keywords
Bronchial washings, fluorescent stain, Mycobacterium tuberculosis
Citation
Bodal Vijay Kumar, Bal Manjit S, Bhagat Sunita, Kishan Jai, Deepika, Brar Rupinder K. Fluorescent microscopy and Ziehl–Neelsen staining of bronchoalveolar lavage, bronchial washings, bronchoscopic brushing and post bronchoscopic sputum along with cytological examination in cases of suspected tuberculosis. Indian Journal of Pathology & Microbiology. 2015 Oct-Dec 58(4): 443-447.