İsmail YÜKSEKOL, Olgaç SEBER, İbrahim BEDİRHAN, Şenol BAL, Arzu BALKAN, Metin ÖZKAN, Ergün TOZKOPARAN, Necmettin DEMİRCİ

Yayma negatif akciğer tüberkülozu tanısında fiberoptik bronkoskopinin değeri

Tüberküloz (Tbc) tanısında altın standart-kültür pozitifliği olmakla birlikte, Dünya Sağlık Örgütü'nün önerdiği başlangıç yaklaşımı, solunum sistemine ait örneklerde asido rezistan basil (ARB)'in saptanmasıdır. Kültür sonuçlarına ulaşıncaya kadar geçen sürede hekim, yayma negatif ya da balgam çıkaramayan hastalar için önemli bir karar vermek durumundadır. Bu hastalar ya kültür sonuçları alınıncaya kadar ilaçsız takip edilecek ya da ampirik anti-Tbc tedavi başlanacaktır. Çalışmamızda yayma negatif ya da balgam çıkaramayan, klinik ve radyolojik olarak akciğer Tbc'sinden kuşkulanılan olgularda fiberoptik bronkoskopi (FOB)'nin tanıya katkısının araştırılması amaçlanmıştır. Çalışmaya yayma negatif akciğer Tbc'si kuşkulu toplam 56 olgu alındı. Tüm olgulara FOB ve rutin bronş lavajı yapıldı. Endobronşiyal anormallik görülen olgularda mukoza biyopsileri, uygun olgularda transbronşiyal parankim ve ince iğne aspirasyon biyopsileri yapıldı. Mikrobiyolojik incelemeler elde edilen materyallerin Ziehl-Hielsen metoduyla boyanması ve Löwenstein-Jensen besiyerine ekim yapılması ile gerçekleştirildi; histopatolojik incelemelerde ise tipik Tbc granülasyon yapısının varlığı araştırıldı. Bronş lavajı ARB direkt bakı 13 (%23) olguda pozitifti. Olguların 28 (%50) 'inde kültür pozitifliği saptandı. Mukoza biyopsisi alınan 20 olgunun sekizinde, transbronşiyal parankim biyopsisi yapılan yedi olgunun dördünde, ince iğne aspirasyon biyopsisi yapılan üç olgunun ikisinde histopatolojik inceleme Tbc lehine değerlendirildi. Bronkoskopik prosedürlerle 27 (%48.21) olguda erken tanı elde edildi. Sonuç olarak; yayma negatif ya da balgam çıkaramayan, klinik ve radyolojik olarak akciğer Tbc'sinden kuşkulanılan olgularda FOB'un önemli bir yeri olduğu ve seçilmiş vakalarda FOB yapılmasının gerekli ue yararlı olduğu kanısına varıldı.

The value of fiberoptic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis

Although mycobacterial culture positivity is the gold standart for the diagnosis, the initial approach to the diagnosis of pulmonary tuberculosis (PTbc) is the detection of acidfast bacilli (AFB) in respiratory specimens as recommended by theWorld'Health Organization. But the physicians have to make a decision for the patients whose sputum smears are negative or who can not produce sputum. Waiting for culture results with radiological follow up or empirical antituberculous therapy are the standart options. In our study we aimed to assess the diagnostic yield of fiberoptic bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negatiue or who could not produce sputum. Fifty six patients who suspected to haue PTbc with sputum smear negatiue were enrolled in the study (fiberoptic bronchoscopy and selective bronchial washings were done to all patients. Bronchial washings were obtained from the affected parts). Mucosal biopsies were done in patients in where endobronchial abnormalities were noted. Transbronchial biopsies were done in selected patients from the radiological localizations'. Ziehl-Nielsen staining and culture in Löwenstein-Jensen medium were the microbiological studies. Typical granulomas were expected to detect on histopathologic examination. Bronchoscopic lavage smears were positive for Mycobacterium tuberculosis in 13 (23%) patients. Twenty eight (50%) patients had positive culture. Histopathological results confirmed tuberculosis in eight of 20 patients who had undergone mucosal biopsies, four of seven of transbronchial biopsies, two of three of needle aspiration biopsies. By bronchoscopic proceduresearly diagnosis was performed in 27 (48.21 %) patients. We concluded that fiberoptic bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. It is useful and necessary in selected cases.

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