Yavuz Selim İNTEPE, Sadettin ÇIKRIKÇIOĞLU, Kürşat EPÖZTÜRK, Murat KIYIK, Ayşin DURMAZ, Hüseyin Cem TİGİN

BALGAM YAYMA NEGATİF, KLİNİK VE RADYOLOJİK OLARAK AKCİĞER TÜBERKÜLOZU DÜŞÜNÜLEN OLGULARDA BAL'DA ARB'NİN TANI DEĞERİ

ÖZET Amaç: Tüberküloz (TB) tanısı balgam veya bronkoskopi meteryallerinde Mycobacterium tubercu- losis saptanması ve radyoloji ile sağlanmaktadır. Ancak her zaman ve her hasta için bu mümkün olamamaktadır. Bu çalışmada klinik ve radyolojik olarak aktif akciğer tüberkülozu düşünülen an- cak 3 tane balgam materyalinde Aside Rezistan Basil (ARB) yayma negatif bulunanlarda Bronkoal- veoler Lavajda (BAL) ARB yayma ve kültür müspetliğinin, invaziv Fiberoptik bronkoskopi (FOB) işlemlerinin TB teşhisine olan katkılarını araştırdık. Gereç ve yöntemler: Klinik ve radyolojik olarak aktif ve/veya sekel akciğer TBu düşünülen, 3 tane balgam yayması negatif olan toplam 89 hasta alındı. Kontrol grubu olarak TB düşünülmeyen fakat tanısal amaçlı bronkoskopi planlanan parankimde konsolidasyon ve/veya interstisyel tutulumu olan hastalar alındı. Bulgular: Vakalar tanı olarak 3 gruba ayrıldı:51 (%57,3) TB, 8 (%9) sekel TB ve 30 (%33,7) TB dışı (TBDG). Tanı, klinik ve radyolojik inceleme, transtorasik iğne aspirasyonu (TTİA), transbronşiyal biyopsi (TBB), transbronşiyal iğne aspirasyonudur (TBİA), BAL ve balgam kültür ile sağlandı. Sonuç: Çalışmamızda balgam çıkaramayan hastalarda indüksiyonla balgam kültürü bakmanın, yayma negatif olan olgularda bronkoskopi ile BAL kültürünün, uygun olgularda TBB veya TBİAnın, ayrıca alınan materyallerin her iki kültür ortamına ekilmesinin de istatistikî olarak tanı değerini arttırdığı sonuçlarına varılmıştır.

Diagnostic Value of Acid Fast Bacilli at BAL in Patients who are Accepted as Clinically and Radiologically Active Tuberculosis with Negative Sputum Smear

ABSTRACT Objective: The diagnosis of tuberculosis (TB) is achieved by using culture of Mycobacterium tuberculosis from sputum or bronchoscopy specimens and radiology. However can not always beensured in each patient. In this study we investigated the contribution of acid-fast bacilli smear and culture positivity on TB diagnosis in bronchoalveolar lavage (BAL) and invasive procedures of fiberoptic bronchoscopy (FOB) in patients with three negative acid-fast bacilli smear in sputum that were suspected of clinically and radiologically active tuberculosis. Materials and Methods: 89 patients whom were suspected of clinically and radiologically active and/or sequelae tuberculosis with three negative sputum smear were included in the study. As the control group patients that were scheduled for bronchoscopy with consolidation or interstitial pattern at parenchyma but not presumed to be tuberculosis were included. Results: Patients are divided to 3 groups based on diagnosis: 51 (%57,3) tuberculosis, 8 (%9) sequelae tuberculosis and 30 (%33,7) nontuberculosis. Diagnosis was achieved by clinical and radiological evaluation, transthorasic needle aspiration (TTİA), transbronchial biopsi (TBB), transbronchial needle aspiration (TBİA), BAL and sputum culture. Conclusion: In our study we found that investigation of sputum culture by induction in smear negative cases, as well inoculation of each specimen to 2 different culture medium, significantly increase the diagnostic value of BAL cultures obtained by bronchoscopy, TBB or TBIA, in patients who can not produce sputum. Key words: Bronchoscopy; Bronchoalveolar lavage; Tuberculosis.

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