The role of routine culture for tuberculosis during bronchoscopy examination of lung masses

BACKGROUND: Many centers routinely culture bronchoscopy samples for mycobacteria even when tuberculosis (TB) is not strongly suspected. The value of this practice has hardly been investigated. OBJECTIVE: The aim of this retrospective study was to assess the utility of routine culture of bronchoscopy samples of lung masses for mycobacteria in a region where TB is not endemic. PATIENTS AND METHODS: The study group consisted of 168 patients who underwent bronchoscopy for investigation of lung masses in a major tertiary-care, university-affiliated facility in central Israel. The findings on acid-fast bacillus staining and culture were reviewed, and data on demographic characteristics were collected from the files. RESULTS: There were 97 men (58%) and 71 women with a mean age of 62 +/- 25 years. One culture (0.6%) grew Mycobacterium tuberculosis. There were no cases of positive acid-fast bacillus smear or positive nontuberculous mycobacteria culture. Sixty USD (5.45%) would be saved per patient without clinical suspicion of TB. CONCLUSIONS: These findings highlight the need to formulate new guidelines for the performance of mycobacterial cultures of bronchoscopy specimens in areas with a low prevalence of TB.     

The value of routine bronchial aspirate culture at fibreoptic bronchoscopy for the diagnosis of tuberculosis

We review the results of bronchial aspirate culture for mycobacteria sent routinely in a series of 1734 fibreoptic bronchoscopic procedures. The incidence of tuberculosis in the series was 8.3% (144 cases). Of these cases, a positive bronchial aspirate culture was obtained in 119 (82.6%) cases, and it was the exclusive means of diagnosis in 64 (44.4%). In 66% of these cases tuberculosis was not suspected at the time of bronchoscopy. Our results suggest that in an area with a high prevalence of tuberculosis, routine bronchial aspirate culture is a useful adjunct to diagnosis.     

Safe sedation during diagnostic and therapeutic flexible bronchoscopy in Japan: A review of the literature

We explored whether a combination of an opioid (fentanyl or pethidine) and midazolam could safely sedate Japanese patients undergoing bronchoscopic procedures.We searched the PubMed Medline and Igaku Chuo Zasshi (ICHUSHI) databases from 1980 to 2022 for papers on sedatives used during bronchoscopy, especially opioids (fentanyl and pethidine) and midazolam. The keywords were “bronchoscopy” and “sedation” (“kikanshikyo” and “chinsei”, respectively, in Japanese).The results showed that midazolam was the preferred sedation agent during flexible bronchoscopy; with midazolam sedation is rapid, and the drug is associated with anterograde amnesia and decreased discomfort. A combination of an opioid (fentanyl or pethidine) and midazolam improved the patient tolerance and willingness to undergo a repeat procedure and also improved the working conditions for the physician. The British Thoracic Society guideline of 2013 suggested that a combination of an opioid (fentanyl or alfentanil) and midazolam should be considered to improve bronchoscopic tolerance. The American College of Chest Physicians Consensus Statement of 2011 suggested that fentanyl should be preferred; the onset of action and peak effect are rapid, and the effects are of relatively short duration. Emphasis has been placed on safety aspects, such as patient monitoring, the precautions that should be taken in patients with certain conditions, prevention and management of complications, adequate staffing, and optimal sedation and disinfection.In conclusion a combined opioid (fentanyl or pethidine) and midazolam sedation is optimal for diagnostic and therapeutic flexible bronchoscopy in Japanese patients.     

Isolated hepatic tuberculosis: report of five cases and review of the literature

Tuberculosis is one of the most common and well-described infectious diseases, with a worldwide distribution and a vast spectrum of clinical manifestations. Involvement of the liver alone by tuberculosis is, however, uncommon. It usually presents as a protracted illness frequently associated with jaundice and hepatomegaly. It can, therefore, mimic primary or metastatic liver malignancies. We report five cases of isolated hepatic tuberculosis, emphasizing the importance of obtaining a tissue diagnosis in all subjects with suspicious liver lesions to avoid missing the uncommon but curable hepatic tuberculosis.     

Diagnosis of abdominal tuberculosis： Experience from 11 cases and review of the literature

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.METHODS: The records of 11 patients (4 males, 7 females,mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white‘miliary nodules‘ or plaques, enlarged lymph nodes, ascites,‘violin string‘ fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis ( M. tuberculosis) in all cases.CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.     

肺血管炎误诊为肺结核5例临床分析及误诊原因探讨

目的探讨肺血管炎误诊为肺结核的原因及预防方法。方法通过对5例肺血管炎误诊为肺结核的临床分析,重点分析肺血管炎误诊原因,探讨诊治方法。结果5例肺血管炎患者均误诊为肺结核,在明确诊断前均进行了不适当的检查和治疗,延误病情,5例中有3例好转出院,2例死亡。结论应提高对肺小血管炎的认识,当患者病情经相应治疗未见好转,应及时检查血周围型抗中性粒细胞胞浆抗体(ANCA),如果有条件应积极进行开胸肺活检或通过胸腔镜活检,争取明确诊断。     

肺血管炎误诊为肺结核5例临床分析及误诊原因探讨

目的探讨肺血管炎误诊为肺结核的原因及预防方法。方法通过对5例肺血管炎误诊为肺结核的临床分析，重点分析肺血管炎误诊原因，探讨诊治方法。结果5例肺血管炎患者均误诊为肺结核，在明确诊断前均进行了不适当的检查和治疗，延误病情，5例中有3例好转出院，2例死亡。结论应提高对肺小血管炎的认识，当患者病情经相应治疗未见好转，应及时检查血周围型抗中性粒细胞胞浆抗体（ANCA），如果有条件应积极进行开胸肺活检或通过胸腔镜活检，争取明确诊断。     

44例肺内结节病诊断方法分析并文献复习

目的回顾性分析肺内结节病的诊治过程,提高诊治水平。方法回顾分析2002年1月至2009年4月在我院住院,经各种检查确诊的肺内结节病患者44例,并复习关于肺内结节病诊断方法进展的文献。结果 44例患者中34例行支气管镜检查,其中20例次行EBB,阳性率35%。14例经纵隔镜、VATS或开胸肺活检,16例行外周淋巴结活检,阳性率均为100%,6例行前斜角肌淋巴结活检,阳性率67%,8例行皮肤病变活检,阳性率75%。结论随着支气管镜技术的发展及EBUS的应用,肺内结节病的诊断准确性增加,从而减少纵隔镜、VATS、开胸肺活检的应用。     

原发于肺的淋巴瘤六例临床分析并文献复习

目的：探讨原发于肺的淋巴瘤的临床特点、诊断、治疗方法，以提高其诊断率。方法：回顾性地总结算1989年－2000年收住北京协和医院的原发于肺的淋巴瘤6例，并结合文献对其临床表现、影像学特点、支气管镜下表现、诊断及治疗方法进行分析。结果：原发于肺的淋巴瘤为少见的淋巴瘤，临床表现不特异，很难确诊。原发于肺的淋巴瘤主要症状为咳嗽（4／6）、发热（2／6）等。影像学可表现为单发或多发的结节或团块影、实变影等，早期无肺门和纵隔淋巴结肿大。支气管镜检查可见支气管狭窄，慢性炎症或大致正常。最终确诊需通过开胸手术、胸腔镜及经皮肺穿获取病灶组织，并结合病理及免疫组化检查。主要治疗手段为手术切除辅以放化疗。预后取决于淋巴瘤的恶性程度。结论：原发于肺的淋巴瘤临床表现不典型，易误诊，及时行必要的有创检查获取组织病理标本有利于早期诊断。     

原发性肺隐球菌病2例分析并文献复习

目的了解原发性肺隐球菌病的临床特征、影像学资料、病理,以提高认识水平。方法报告2例原发性肺隐球菌病患者的临床资料,并通过检索系统的文献共70余篇,总结其临床表现、影像学特点、诊断方法及治疗手段。结果肺隐球菌病的临床表现无特异,影像学改变有差异,诊断依赖病理学,治疗尚存在争议。结论肺隐球菌病的发病率逐年增高,经皮肺穿刺活检是一种简单有效的诊断方法。