Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

Detection of tuberculosis in smear predator pulmonary TB in Fayoum Chest Hospital

Egyptian Journal of Bronchology volume 12, pages 473–481 (2018)Cite this article

Abstract

Background

Tuberculosis (TB) is one of the causes of health problem in millions of people annually, and in 2015, it was one of the top 10 reasons of doom worldwide, ranking above HIV/AIDS as one of the important causes of death owing to an intended disease.

A negative smear result in pulmonary TB is believed to be a widespread clinical problem, so early detection of smear-negative pulmonary tuberculosis (SNPTB) is important for TB control and restriction of number of deaths, and it is tricky in these patients.

Aims

To detect TB in SNPTB in Fayoum Chest Hospital

Design

This was a retrospective study.

Setting

Fayoum Chest Hospital and Fayoum University Hospital in Egypt were used for conducting the study between 2015 and 2017.

Patients and methods

Fifty patients suspected to have pulmonary TB and had negative sputum smear results were included in the study.

For each patient, full history was taken, and clinical body checkup was done. Then, plain posteroanterior chest radiograph was done. Tuberculin test, direct sputum examination, and other diagnostic methods used for detection such as GeneXpert, bronchoscopy, bronchoalveolar lavage (BAL), transbronchial lung biopsy, Löwenstein–Jensen culture, QuantiFERON, or even open lung biopsy were recorded.

Statistical analysis

Coding of the data was done then entered with SPSS (Statistical Package for the Social Sciences) version number 18 windows 7 after that data were summarized using mean, standard deviation, median, minimum and maximum in the quantitative data with using frequency (count) & relative frequency (percentage) for categorization of data.

Results

It was found that 42% of patients were diagnosed by GeneXpert and 46% were diagnosed by BAL during bronchoscopy, whereas 68% of patients had positive ‘Löwenstein–Jensen culture’ result.

Conclusion

The GeneXpert MTB/RIF assay is an important test for quick diagnosis of acid-fast bacilli SNPTB.

Flexible fiberoptic bronchoscopy is a beneficial tool in the diagnosis of pulmonary TB in patients whose sputum smear is negative.

Clinical implications are as follows: in patients with SNPTB, microbiological samples should be obtained (through sputum, BAL, or induced sputum), and then radiological investigation should be performed. Thereafter, antituberculous treatment should be started following the diagnosis, with follow-up of the case.

Rapid detection and proper treatment of pulmonary TB, even in smear negative patients, can eliminate spread of the infection to others and may decrease the severity of the disease.

References

  1. Shaarrawy H, Zeidan M, Nasr A, Nouh M. Assessment of the role of high resolution computed tomography in the diagnosis of suspected sputum smear negative active PTB. Egypt J Chest Dis Tuberc 2013;62:263–268.

    Article  Google Scholar 

  2. Alavi NR, Cuevas LE, Squire SB. Clinical and laboratory diagnosis of the patients with sputum smear negative pulmonary tuberculosis. Arch Iran Med J 2012;15:22–26.

    Google Scholar 

  3. Tozkoparana E, Deniza O, Ciftcid F. The roles of HRCT and clinical parameters in assessing activity of suspected smear negative pulmonary tuberculosis. Arch Med Res J 2005;36:166–170.

    Article  Google Scholar 

  4. World Health Organization. Global tuberculosis report. 2016. Available at:http://who.int/tb/publications/factsheet_global.pdf. [Accessed 5 March 2017].

  5. Daniel TM. The history of tuberculosis. Respir Med J 2006;100:1862–1870.

    Article  Google Scholar 

  6. Bouros D, Zeros G, Panaretos C. Palpation vs pen method for the measurement of skin tuberculin reaction (Mantow test). Chest J 1991;99:416–419.

    Article  CAS  Google Scholar 

  7. Holst E, Mitchison DA, Radhakrishna S. Examination of smears for tubercle bacilli by fluorescence microscopy. Indian J Med Res 1959;47:495–499.

    CAS  PubMed  Google Scholar 

  8. Yeh JJ, Yu JK, Teng WB. High-resolution CT for identify patients with smear-positive, active pulmonary tuberculosis. Eur J Radiol 2012;81:195–201.

    Article  Google Scholar 

  9. Reider HL, Van Deun A, Kam KM. Grading scales for bright field (Ziehl-Neelsen) and fluorescence microscopy, priorities for tuberculosis bacteriology services in low-income countries. 2nd ed. Paris, France:International Union Against Tuberculosis and Lung Disease; 2007.

    Google Scholar 

  10. National TB control program Guidelines of Egypt (NTP). National tuberculosis control program. Egyptian:Ministry of Health and Population; 2017.

    Google Scholar 

  11. Pagana KD, Pagana TJ. Mosby ’s manual of diagnostic and laboratory tests. 4th ed. St Louis, MO :Mosby 2010.

  12. Sohair AA, Yasser MI, Sahar MA, Ahmad AM. Comparative study between using QuantiFERON and tuberculin skin test in diagnosis of Mycobacterium tuberculosis infection. Egypt J Chest Dis Tuberc 2013;62:137–143.

    Google Scholar 

  13. Hernandez E, Cook V, Kunimoto D. Transmission of tuberculosis from smear negative patients:a molecular epidemiology study. Thorax J 2004;59:286–290.

    Article  Google Scholar 

  14. Foulds J, O’Brien R. New tools for the diagnosis of tuberculosis:the perspective of developing countries. Int J Tuberc Lung Dis 1998;2:778–783.

    CAS  PubMed  Google Scholar 

  15. Ghoma Linguissi LS, Vouvoungui CJ, Poulain P, Essassa GB, Kwedi S, Ntoumi F. Diagnosis of smear-negative pulmonary tuberculosis based on clinical signs in the Republic of Congo. BMC Res Notes 2015; 8:804.

    Article  Google Scholar 

  16. Rao S. Tuberculosis and patient gender:an analysis and its implications in tuberculosis control. Lung India 2009;26:46–47.

    Article  Google Scholar 

  17. Fatma AA, Mohammad AF, Hala MS. Study of the experience of Tamyia central hospital in management of pulmonary and extra pulmonary tuberculous patients in the period of January 2009#XPS#ndash;June 2010 [thesis]. Cairo, Egypt:Ain Shams University; 2012.

    Google Scholar 

  18. Leung CC, Yew WW, Chan CK. Smoking and tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2003;7:980–986.

    CAS  PubMed  Google Scholar 

  19. Samb B, Henzel D, Daley CL. Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative. Int J Tuberc Lung Dis 1997;1:25–30.

    CAS  PubMed  Google Scholar 

  20. Shin JA, Chang YS, Kim TH. Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis. BMC Infect Dis 2012; 12:141.

    Article  Google Scholar 

  21. Lee HM, Shin JW, Kim JY. HRCT and whole-blood interferon-gamma assay for the rapid diagnosis of smear-negative pulmonary tuberculosis. Respiration 2010;79:454–460.

    Article  CAS  Google Scholar 

  22. Kanaya AM, Glidden DV, Chamber HF. Identifying pulmonary tuberculosis in patients with negative sputum smear results. Chest 2001;120:349–355.

    Article  CAS  Google Scholar 

  23. Choi JC, Shin JW, Kim JY. The effect of previous tuberculin skin test on the follow-up examination of whole-blood interferon-gamma assay in the screening for latent tuberculosis infection. Chest 2008;133:1415–1420.

    Article  CAS  Google Scholar 

  24. Nakanishi M, Demura Y, Ameshima S. Utility of high-resolution computed tomography for predicting risk of sputum smear-negative pulmonary tuberculosis. Eur J Radiol 2010;73:545–550.

    Article  Google Scholar 

  25. Caliskan T, Ozkisa T, Aribal S. High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status. J Thorac Dis 2014;6:706–712.

    PubMed  PubMed Central  Google Scholar 

  26. Opota O, Senn L, Prod’hom G. Added value of molecular assay Xpert MTB/RIF compared to sputum smear microscopy to assess the risk of tuberculosis transmission in a low-prevalence country. Clin Microbiol Infect 2016;22:613–619.

    Article  CAS  Google Scholar 

  27. Boehme CC, Nabeta P, Hillemann D. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010;363:1005–1015.

    Article  CAS  Google Scholar 

  28. Affolabi D, Akpona R, Odoun M, Alidjinou K, Wachinou P, Anagonou S, et al. Smear-negative, culture-positive pulmonary tuberculosis among patients with chronic cough in Cotonou, Benin. Int J Tuberc Lung Dis 2011;15:67–70.

    CAS  PubMed  Google Scholar 

  29. Mitchison DA. Examination of sputum by smear and culture in case-finding. Bull Int Union Tuberc J 1968;41:139–147.

    CAS  Google Scholar 

  30. Altaf Bachh A, Gupta R, Haq I, Varudkar HG. Diagnosing sputum/smear-negative pulmonary tuberculosis:does fibre-optic bronchoscopy play a significant role? Lung India J 2010;27:58–62.

    Article  Google Scholar 

  31. Danek SJ, Bower JS. Diagnosis of pulmonary tuberculosis by flexible fibreoptic bronchoscopy. Am Rev Respir Dis J 1979;119:677–679.

    CAS  Google Scholar 

  32. Purohit SD, Sisodia RS, Gupta PR. Fibreoptic bronchoscopy in the diagnosis of smear negative pulmonary tuberculosis. Lung India 1983;1:143–146.

    Google Scholar 

  33. Kulpati DD, Heera HS. Diagnosis of smear negative pulmonary tuberculosis by flexible fibreoptic bronchoscopy. Indian J Tuberc 1986;33:179–182.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chest Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt

    Assem F. Al Essawy & Randa I. Ahmed MD Degree of Pulmonology

  2. Clinical Pathology in Faculty of Medicine, Fayoum university, Fayoum, Egypt

    Fadwa A. E. Raheem (Lecturer)

  3. Fayoum Chest Hospital, Fayoum university, Fayoum, Egypt

    Heba M. Bakri

Authors
  1. Assem F. Al Essawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Randa I. Ahmed MD Degree of Pulmonology
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fadwa A. E. Raheem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heba M. Bakri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Randa I. Ahmed MD Degree of Pulmonology.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al Essawy, A.F., Ahmed, R.I., Raheem, F.A.E. et al. Detection of tuberculosis in smear predator pulmonary TB in Fayoum Chest Hospital. Egypt J Bronchol 12, 473–481 (2018). https://doi.org/10.4103/ejb.ejb_119_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_119_17

Keywords