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Comparative Study
. 2020 Mar 18;20(1):229.
doi: 10.1186/s12879-020-04954-3.

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

Cynthia Pessoa Neves  1   2 , Allyson Guimarães Costa  3   4   5   6 , Izabella Picinin Safe  1   2 , Alexandra de Souza Brito  1   2 , Jaquelane Silva Jesus  2 , Afranio Lineu Kritski  7 , Marcus Vinicius Guimarães Lacerda  1   2   8 , Miguel Viveiros  9 , Marcelo Cordeiro-Santos  1   2
Affiliations
Comparative Study

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

Cynthia Pessoa Neves et al. BMC Infect Dis. .

Abstract

Background: The detection of Mycobacterium tuberculosis (MTB) in the intensive care unit (ICU) presents several challenges, mainly associated to the clinical state of the patient. The presence of HIV infection further aggravates this scenario, requiring a reliable collection method, with better performance in the microbiological/molecular techniques to be used. We evaluated the performance of two methods for sample collection, mini bronchoalveolar lavage (Mini-BAL) and endotracheal aspirate (ETA), for diagnosis of pulmonary tuberculosis (PTB) in critically ill patients.

Methods: This prospective study involved 26 HIV positive ICU internalized patients, with presumptive PTB who required mechanical ventilation. Two samples were obtained prospectively from 26 HIV ICU patients with presumptive PTB by Mini-BAL and ETA. The samples were processed for smear microscopy, Löwenstein-Jensen medium and the BACTEC Mycobacteria Growth Indicator Tube 960 system®. We define as confirmed PTB patients with positive MTB culture. Furthermore, all samples obtained through the Mini-BAL were analyzed by Xpert® MTB/RIF.

Results: Our results demonstrated that the respiratory samples obtained by Mini-BAL were able to increase MTB detection in critically ill patients with presumptive PTB. The Mini-BAL allowed 30% increased recovery and guaranteed enough sample volume for processing in all methods. In addition, the larger volume of the samples obtained with this technique enabled the Xpert® MTB/RIF molecular test for diagnosis of TB.

Conclusions: The Mini-BAL showed be an acceptable alternative to ETA in this population, since these critically ill and often-immunocompromised patients are more likely to develop complications related to invasive procedures.

Keywords: Diagnosis; Intensive care medicine; Mini-BAL; Pulmonary tuberculosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study and laboratorial analysis flowchart of the ICU internalized patients
Fig. 2
Fig. 2
Median of Volume recovery in Mini-BAL and ETA of the ICU internalized patients
See this image and copyright information in PMC

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