IP Indian Journal of Immunology and Respiratory Medicine


Diagnostic role of gastric aspiration in sputum negative pulmonary tuberculosis


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Article Type : Research Article

Author Details: Gayathri Ganapathy*,Sathish Kumar Mani,Anbumaran Parivakkam Mani,Gangadharan Vadivelu

Volume : 4

Issue : 3

Online ISSN : 2581-4222

Print ISSN : 2581-4214

Article First Page : 176

Article End Page : 180


Abstract

Introduction: Tuberculosis is one of the deadly diseases claiming a mortality rate 2.7 million lives, emphasise the need for early diagnosis and treatment initiation. But the diagnosis of sputum negative pulmonary tuberculosis is challenging even with a procedure like bronchoscopy which demands technical expertise and monitoring. Also the problem experienced at the grass root level is collection and transportation of sputum for CB-NAAT mycobacterium detection to the lab and results generation takes more than 1 week. Hence, a diagnostic test which is more feasible even to the primary health centre has to be established. Gastric aspirate though performed among the paediatric age group, its role in diagnosis of sputum negative pulmonary tuberculosis among adult patients is taken up in our study.
Methodology: Patients above 18 years of age with pulmonary TB suspicion are tested for sputum for AFB followed by chest skiagram. Those with sputum negative and chest X-ray features suggestive of tuberculosis are included into the study. Early morning gastric aspirate with the nasogastric tube is performed. Buffered sample is processed and examined for AFB and culture testing in LJ medium.
Results: 125 patients (102 male/23 female) satisfied the inclusion criteria were divided under the following categories as a) sputum smear negative for AFB (82) b) No sputum production (26) and c) morbidly sick (17). The diagnostic yield of smear positive in gastric aspirate was 24% (31), while the gastric aspirate cultured in LJ medium found to be positive for MTB in 22% (28). Four patients were positive for post gastric aspirate sputum for AFB. Among 22 patients who underwent bronchoscopy, seven were found to be positive for AFB.
Conclusions: The positivity of AFB in smear and culture in gastric aspirate was 24% and 22% respectively. Hence gastric aspirate can be employed as a tool for diagnosis among sputum negative pulmonary tuberculosis.

Keywords: Acid fast bacilli; Diagnostic bronchoscopy; Gastric aspiration; Sputum Negative pulmonary tuberculosis.

Doi :-https://doi.org/10.18231/j.ijirm.2019.039