FLEXIBLE BRONCHOSCOPY AS A DIAGNOSTIC-TOOL IN THE EVALUATION OF PULMONARY TUBERCULOSIS IN AN ELDERLY POPULATION

Objective: This study intends to determine what role fiberoptic bronch oscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population. Design: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (<65 years) and Group B (greater -than-or-equal-to 65 years). Natural sputum smears and cultures positi ve for M. tuberculosis (M. TB) in each group were compared with FOB sp ecimens, acid-fast bacilli (AFB) smears and cultures. Data were analyz ed by chi-square tests of independence for each year, then compared to determine statistical significance. Setting and Patients: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC-approved criteria fo r diagnosis of tuberculosis. Measurements: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with s putum negative but FOB specimens positive for TB, identification was m ade by FOB only. Main Results: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultu res; the remaining 54 patients (17.1%) had diagnoses based on FOB alon e. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14 .1%) were diagnosed by FOB. There were 256 TB cases reported among Gro up B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significan t difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age <65), the difference in rates for tho se in Group B (age greater-than-or-equal-to 65) was statistically sign ificant (P < 0.05). Conclusions: A steady increase in the use of FOB a s a diagnostic tool was noted, suggesting that a significant number (1 9.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known , this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.