Bronchoscopy is useful for diagnosing smear-negative tuberculosis in HIV-infected patients: Table 1–

Bronchoscopy is useful for diagnosing smear-negative tuberculosis in HIV-infected patientsTo the Editors: Tuberculosis (TB) is the leading cause of morbidity and mortality in HIV-infected patients in sub-Saharan Africa [1], in part because limited availability of diagnostic tests hinders early, directed treatment.Studies have demonstrated a substantial yield of bronchoscopy for diagnosing HIVassociated opportunistic pulmonary diseases, but few studies have explicitly considered whether bronchoscopy adds to the sensitivity of sputum culture in identifying Mycobacterium tuberculosis, or whether bronchoscopy shortens the time needed to diagnose TB.Although bronchoscopy is unavailable in many HIV and TB endemic settings, where it is available its usefulness for TB diagnosis is uncertain.Thus, we examined the performance of bronchoscopy to diagnose TB and other pulmonary diseases in HIV-infected inpatients with cough in Kampala, Uganda.We performed a prospective cross-sectional study enrolling consecutive HIV-infected patients aged o18 yrs hospitalised at Mulago Hospital with cough of o2 weeks but ,6 months duration.After providing informed consent, patients underwent a standard evaluation including chest radiography, sputum acid-fast bacillus (AFB) microscopy and bronchoscopy with bronchoalveolar lavage (BAL) if they were AFB smearnegative, according to previously described protocols [2].Trained technicians examined BAL by smear and/or culture for mycobacteria, Pneumocystis jirovecii, and other fungi.Specific pneumonia treatment was recorded.Patients were seen at a 2-month follow-up visit, after which a pulmonologist and a medical officer assigned final diagnoses based on all diagnostic information and according to a standardised protocol.A final diagnosis of pulmonary TB was based on a positive sputum mycobacterial culture (using Lowenstein-Jensen media), positive BAL AFB smear or BAL mycobacterial culture, or a clinical response to TB treatment at the 2-month follow-up visit.