Role of Bronchoalveolar Lavage (BAL) Gene Xpert in Diagnosis of PTB in Sputum Smear Negative Patients

KM Monjurul Alom, Mirza Mohammad Idris Ali, Md Jakaria Mahmud, Mohiuddin Ahmed
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Abstract

The aim of this study was to assess the diagnostic efficacy of Xpert MTB/RIF assay in bronchoalveolar lavage (BAL) in the diagnosis of pulmonary tuberculosis in sputum-smear negative patients. This observational case series study was conducted in a tertiary base institute of Bangladesh from July 2017 to June 2019. All patients with suspected pulmonary tuberculosis who were sputum-smear negative, irrespective of age and gender were included in this study. BAL fluid thus obtained and examined the smear for acid fast bacilli (AFB) and Xpert MTB/RIF assay. The sensitivity, specificity and accuracy values were calculated for smear AFB and Xpert MTB/RIF assay. Xpert MTB/RIF was identified 33 (36.7%) of 90 patients on bronchoalveolar lavage fluid in the final analysis. AFB Fluid culture was positive in 28 (31.2%) cases. The sensitivity and specificity of Xpert MTB/RIF assay was 85.7%, and 85.5% respectively. The positive likelihood ratio was 5.90, and the negative likelihood ratio was 0.167. The accuracy was 85.56%. Xpert MTB/RIF on BAL fluid can be recommended as a fruitful diagnostic tool for mycobacterium pulmonary tuberculosis especially in sputum smear negative, and culture negative patients. CBMJ 2023 January: Vol. 12 No. 01 P: 60-66
支气管肺泡灌洗(BAL)基因Xpert在痰涂片阴性患者PTB诊断中的作用
本研究的目的是评估Xpert支气管肺泡灌洗(BAL) MTB/RIF检测对痰涂片阴性患者肺结核的诊断效果。该观察性病例系列研究于2017年7月至2019年6月在孟加拉国的一个三级基地研究所进行。所有痰涂片阴性的疑似肺结核患者,不论年龄和性别,均纳入本研究。由此获得BAL液并检测抗酸杆菌(AFB)涂片和Xpert MTB/RIF试验。计算涂片AFB和Xpert MTB/RIF检测的敏感性、特异性和准确性。90例支气管肺泡灌洗液患者中有33例(36.7%)被确定为MTB/RIF。AFB液体培养阳性28例(31.2%)。Xpert MTB/RIF检测的灵敏度和特异性分别为85.7%和85.5%。阳性似然比为5.90,阴性似然比为0.167。准确率为85.56%。对BAL液的Xpert MTB/RIF可推荐作为肺结核分枝杆菌的有效诊断工具,特别是在痰涂片阴性和培养阴性患者中。中华医学杂志2023年1月12期01期60-66页
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