Diagnostic utility of bronchoalveolar lavage in children wit
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Bronchoscopy can be a useful tool in children with pulmonary tuberculosis (PTB) with severe disease potentially requiring intervention or in the face of diagnostic dilemmas. The aim of this study was to determine the value of Xpert MTB/RIF assay (Xpert) on bronchoalveolar lavage (BAL) samples in children with complicated PTB.

Retrospective analysis was done of children with clinically diagnosed PTB, who underwent routine bronchoscopy over a 5 year period at a large referral hospital. BAL and other respiratory samples were tested by microscopy, culture, and Xpert. Researchers explored whether clinical, radiographic and bronchoscopy findings, and duration of antituberculosis treatment were associated with bacteriological confirmation.

Results:
--112 out of 146 children were on antituberculosis treatment for a median of 10 days at the time of bronchoscopy.

--Overall, bacteriological confirmation was achieved in 115, with 101 detected on BAL.

--Of those bacteriologically confirmed on BAL, 61.4% were positive by both Xpert and culture, 34.7% only by Xpert, and 3.9% only by culture.

--Sensitivity and specificity of Xpert compared with culture on BAL samples for children not on antituberculosis treatment were 94.1% and 68.7%, respectively.

In conclusion, Xpert BAL research had a high diagnostic yield in children undergoing bronchoscopy for complicated PTB who were already on antituberculosis care. If noninvasive respiratory specimens fail to validate complicated TB, bronchoscopy should be considered.

Source: https://onlinelibrary.wiley.com/doi/10.1002/ppul.25405?af=R
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