Tayfun ÇALIŞKAN, Tayfun KARTALOĞLU, Oğuzhan OKUTAN, Erkan BOZKANAT, Faruk ÇİFTÇİ, Dilaver TAŞ, Ogün SEZER

Akciğer tüberkülozu tanısında açlık mide suyu yayma ve kültür incelemesinin etkinliği

Amaç: Araştırmamızda balgam yayma pozitif hastalar ile yeterli veya hiç balgam çıkaramayan akciğer tüberkülozlu hastalardan alınan açlık mide suyunun (AMS) tanısal duyarlılığını ortaya koymaya çalıştık. Gereç ve yöntem: Balgam yaymada en az iki kez tüberküloz basili saptanan veya radyolojik ve klinik olarak akciğer tüberkülozu şüphesi olan ve bir kez yayma pozitifliği saptanan 29 akciğer tüberkülozlu hastadan bir kez AMS alındı ve asiderezistan basil (ARB) incelemesi yapıldı ve kültüre ekildi. Yeterli veya hiç balgam çıkaramayan 134 hastadan bir kez AMS alındı. Bu hastalarda da ARB incelemesi yapıldı ve kültüre ekildi.Bulgular: Radyolojik yaygınlık arttıkça etkeni mikroskopik olarak gösterme ve/ veya kültürde üretme olasılığı artmaktadır (p = 0,0001, r = -0,60). Ancak kavite olup olmaması ile basil elde etme arasında bir ilişki saptanamamıştır (p = 0,317, r = 0,239). Balgam yayma pozitifliği altın standart olarak alınan hastalarda, bir kez alınan AMS yayma duyarlılığı %51,7, kültür duyarlılığı %62 ve toplam duyarlılık %79 olarak bulunmuştur. Klinik ve radyolojik olarak akciğer tüberkülozu şüpheli hastalarda ‘tedaviden tanıya' kriteri altın standart olarak alındığında AMS yayma duyarlılığı %23,8, kültür duyarlılığı %42,5 ve toplam duyarlılık %47 olarak bulunmuştur.Sonuç: Tüberkülozun kesin tanısı bakteriyolojik olarak konulduğundan dolayı AMS tanıya önemli oranda katkı yapmaktadır.Balgam yayma pozitif hastalarda AMS yayma + kültür duyarlılığı %79 ve yeterli veya hiç balgam çıkaramayan hastalarda AMS yayma + kültür duyarlılığı %47 olarak bulunmuştur.

Efficacy of gastric lavage smear and culture examination for the diagnosis of pulmonary tuberculosis

Objective: Examining gastric lavage (GL) smear and culture for pulmonary tuberculosis, we assessed diagnostic sensitivity of gastric lavage in patients who had sputum smear positivity or those who weren't able to expectorate enough sputum. Materials and methods: GL was obtained from 29 patients who had two smear positivity or one smear positivity with clinical and radiological evidence of pulmonary tuberculosis. Sampling of gastric lavage was examined for acid fast bacilli (AFB) and cultured for M tuberculosis. All the same GL was obtained from 134 patients who weren't able to expectorate enough sputum. GL smear was also examined and cultured for M tuberculosis in these patients.Results: Probability of detecting acid fast bacilli (AFB) and growing M tuberculosis was found to increase so far as radiologic extensivity is excessive (p=0.0001, r = -0.60). However there wasn't a relation between whether there is a cavity view on radiography or there is a detection of AFB (p=0.317, r=0.239). If sputum smear positivity is accepted as gold standart in the diagnosis of pulmonary tuberculosis, sensitivity of gastric lavage smear examination was found as 51.7% and sensitivity of culture was found as 62%. Total sensitivity of smear and culture examination was found as 79%.Without microbiological evidence of AFB in the sputum, if diagnosis of tuberculosis that was established by the criteria of ‘from treatment to diagnosis' in patients with suggestive of tuberculosis clinically and radiologically is accepted as gold standart, the sensitivity of gastric lavage smear examination was found as 23.8% and the sensitivity of the culture was found as 42.5%. Total sensitivity of smear and culture examination was found as 47%.Conclusion: Because of the definitive diagnosis of pulmonary tuberculosis relies on identifying or culturing Mycobacterium tuberculosis from respiratory specimens, GL AFB examination importantly contributes to diagnose pulmonary tuberculosis. Total sensitivity of GL smear and culture was found as 79% in patients with sputum smear positive pulmonary tuberculosis and 47% in patients who weren't able to expectorate enough sputum.

PDF

___

1) Dickson SJ, Brent A, Davidson RN, Wall R. Comparison of bronchoscopy and gastric washings in the investigation of smear-negative pulmonary tuberculosis. Clin Infect Dis 2003; 37:1649-1653.
2) Okutan O, Kartaloglu Z, Kilic E, Bozkanat E, Ilvan A. Diagnostic contribution of gastric and bronchial lavage examinations cases suggestive of pulmonary tuberculosis. Yonsei Med J 2003; 44:242-248.
3) Özkara Ş, Aktaş Z, Özkan S, Ecevit H. Türkiye'de Tüberkülozun Kontrolü İçin Başvuru Kitabı, T.C. Sağlık Bakanlığı Verem Savaşı Daire Başkanlığı, Ankara 2003.
4) Rizvi N, Rao NA, Hussain M. Yield of gastric lavage and bronchial wash in pulmonary tuberculosis. Int J Tuberc Lung Dis 2000; 4:147-151.
5) Rossman MD, Oner Eyupoglu AF. Clinical presentation and treatment of tuberculosis. In Fishman AP (ed). Fishman's Pulmonary Disease and Disorders. Mc Graw Hill. New York, USA, 3rd ed. 1998; pp 2486-2487.
6) Saka D, Çalışır HC, Öğretensoy M. The place of gastric lavage in diagnosis of pulmonary tuberculosis. ERS 8th Annual Congress 19-23 September 1998; Geneva, Switzerland, p.1489.
7) Sanjay KG, RP Tiwari, Dileep T, Rupinder S, Dolly M, VK Ramnani, GBKS Prasad, Ramesh C, M Fraziano, V Colizzi, Prakash SB. Diagnosis of tuberculosis: Available technologies, limitations and possibilities. J Clin Lab Anal 2003; 17:155-163.
8) Singh M, Moosa NVA, Kumar L, Sharma M. Role of gastric lavage and broncho-alveolar lavage in the bacteriological diagnosis of childhood pulmonary tuberculosis. Indian Pediatrics 2000; 37: 947-951.
9) Somoskövi A, Zissel G, Zipfel PF, Ziegenhagen MW, Klaucke J, Haas H, Schlaak M, Mullerquernheim J. Different cytokine patterns correlate with the extension of disease in pulmonary tuberculosis. Eur Cytokine Net 1999; 10: 135-142.
10) Tahaoğlu K, Kızgın O, Karagöz T, Tor M, Partal M, Sadoglu T. High initial and acquired drug resistance in pulmonary tuberculosis in Turkey. Tuber Lung Dis 1994; 75:324-328.
11) Wilcke JT, Kok-Jensen A. Diagnostic strategy for pulmonary tuberculosis in a low-incidence country: Results of chest Xray and sputum cultured for Mycobacterium tuberculosis. Respir Med 1997; 91:281-285.
12) Zar HJ, Hanslo D, Apolles RN, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: A prospective study. Lancet 2005; 365:13-34.