BRONCHOALVEOLAR LAVAGE IN PULMONARY TUBERCULOSIS - A DECISION-ANALYSIS APPROACH

We assessed the utility of bronchoalveolar lavage (BAL) in the diagnos is of pulmonary tuberculosis (PTB) in 50 consecutive HIV-negative pati ents with clinical acid radiographic findings suggestive of PTB, but w ith negative microscopy for acid-fast bacilli (AFB) on sputum smear. P atients were grouped, using a scoring system, into relative likelihood s of having PTB (I-IV, in descending probability), Patients were start ed on anti-tuberculosis treatment according to the BAL results. Bacter iological diagnosis of PTB was confirmed in 22/50 BAL; 11 (91.6%), sev en (37%) and four (40%) of groups I-III, respectively. In 13 cases, an early diagnosis of PTB was made by positive microscopy for AFB on BAL ; an alternative diagnosis was made in six cases (bacterial pneumonia 4, carcinoma 2). A decision analysis model was created to assess the o verall utility of BAL. This suggested that in a region of high PTB pre valence, and when the clinical diagnosis of PTB is likely, empirical t reatment is the best course of action, with BAL being reserved for fur ther investigation of non-responders. Early BAL should be considered w hen the diagnosis of PTB is uncertain.