THE OPTIMIZATION OF BACTERIOLOGICAL INVESTIGATION IN THE CASES OF PULMONARY TUBERCULOSIS WITH NEGATIVE MICROSCOPIC EXAMINATION, FOR ACID- FAST BACILLI (AFB), OF SPONTANEOUS SPUTUM CULTURE
Abstract:
Introduction. Tuberculosis continues to remain a major public health issue in Romania, the level of
TB incidence at present placing our country among the first places in the European Union. Pulmonary
tuberculosis (TB) is the most common way of localization of the disease in the adult patient (over 90%), the
level of bacteriological confirmations of newly proven cases being, over the last few years (2006-2008),
around 50%-70%. Aims. The evaluation of the input of special techniques for cough and expectoration
induction (sputum induced by aerosol exposure with 5% of saline solution), along with methods of sputum
culture (normal saline solution lavage and bronchial aspirate by fibrobronchoscopical examination.)
Materials and methods. The object of study was a group of patients hospitalized with the diagnosis of
pulmonary tuberculosis who, apart from the standard process of sputum culture and processing, received
treatment by means of ultrasonic aero Venturi type face-mask, together with lavage and bronchial aspirate by
endoscopic examination. The recorded issues were: the aspect of products taken, the results of bacteriological
examinations carried out for negative sputum-smear for acid-fast bacilli (AFB), by means of microscopy and
culture (C) of the products taken, adverse effects and necessary costs. Results. Bacteriological examinations of
induced sputum proved to be valid through microscopic examination (M+) for seven patients and through
culture (M-,C+) for nine patients, having a diagnostic sensitivity of 18,1%. Then, the examinations of
bronchial lavage liquid confirmed 4 patients (4%) through microscopy and 8 patients (8%) through culture,
with a diagnostic sensitivity of 14%. The methods used were considered to be accurate and valid, with minor
adverse events, applicable to routine practice and also low cost. Conclusions. The results of this study prove
the importance in implementing all the recommendations made by the Tuberculosis National Control
Programme concerning sputum culture, in order to obtain the best results (bacteriological confirmations) in
pulmonary tuberculosis.
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