Fibreoptic bronchoscopy in rapid diagnosis of sputum smear negative pulmonary tuberculosis

We used fibreoptic bronchoscopy to investigate 70 patients with a suspected diagnosis of pulmonary tuberculosis, with histology of any visible lesion and examination of washings by Ziehl-Neelsen Stain and Lowenstein-Jensen culture, and in later cases BACTEC rapid culture technique. Thirty-five patients were considered to have tuberculosis in the light of the course of the illness and response to treatment. In these, chest radiology showed lung parenchymal lesions (LPL) with or without enlarged hilar or mediastinal glands in 18, and mediastinal gland enlargement (MGE) only in 17. In nine patients (four with MGE, five with LPL) the diagnosis of tuberculosis was confirmed by culture or histology of samples taken at bronchoscopy, and in five of these the diagnosis was available within 16 days of bronchoscopy. Of seven patients with positive cultures two had resistant organisms. There were no complications. Fibreoptic bronchoscopy provides early confirmation of diagnosis, and cultures to permit sensitivity studies, in a useful proportion of patients who traditionally present a considerable problem in diagnosis.