Author/Editor     Eržen, Damijan; Triller, Nadja; Žolnir-Dovč, Manca; Zalokar, Polona; Šorli, Jurij
Title     Bronhoskopska diagnostika pljučne tuberkuloze
Translated title     Bronchoscopic diagnosis of pulmonary tuberculosis
Type     članek
Source     Endoskopska revija
Vol. and No.     Letnik 7, št. 18
Publication year     2002
Volume     str. 50-3
Language     slo
Abstract     Control of tuberculosis is based on the identification and treatment of cases of active tuberculosis and latent infection. The examination of aproppriate morning sputum for mycobacteria is the basis of diagnosis, and mycobacterial culture is the golden standard for establishing a definitive diagnosis of tuberculosis. Fiberoptic bronchoscopy is used in the diagnosis of tuberculosis when it might not be possible for a patient to procedure a sputum sample, or sputum samples are negative for AFB. Invasive diagnostic testing is necessary because fast diagnosis is mandatory to exclude lung cancer, fungal infection or tuberculosis with resistant bacilli. During the procedure, characteristic bronchoscopic findings can be found to establish a diagnosis of endobronchial tuberculosis: inflamatory granulations and ulcerations, and after inflammation bronchostenosis, bronchial deformation, bronchila scars and mucosal pigmantations. Bronchial washing had the highest yield in fiberoptic bronchoscopy. Nucleic acids amplification test was positive in 45% of the cases, specificity was 100%. Transmission of tuberculosis through the bronchoscope can occur. Strict attention has to be complied with all of the recommendations of the procedur for the disinfection. Mechanical cleaning prior to procedure has to be very thorough. Medical and nursing staff can be protected from the infection by aerosol with masks and ventilation of the bronchoscopy suite.
Summary     Nadzor nad epidemijo tuberkuloze temelji na odkrivanju in zdravljenju bolnikov z aktivno tuberkulozo in ljudi z latentno okužbo. Temeljni diagnostični postopek za dokaz pljučne tuberkuloze je ustrezni odvzem in vrednotenje svežega jutranjega izmečka, osamitev bacilov tuberkuloze iz izmečka pa zlati standard za diagnozo. Bronhoskopija se uporablja v diagnostiki tuberkuloze, kadar pri bolniku ni moč odvzeti ustreznega izmečka ali pa so rezultati mikroskopije negativni-odvzeti so bili vsaj trije kakovostni izmečki ali inducirani izmečki, pa so zaradi potrebe po hitri osamitvi bacilov nujni invazivni diagnostični posegi, posebej kadar obstaja sum za pljučnega raka, gljivično okužbo ali tuberkulozo, povzročeno z odpornimi bacili. Med preiskavo smo pozorni na bronhoskopske znake endobronhialne tuberkuloze: vnetne granulacije in ulceracije, po vnetju pa bronhostenoza, deformacije bronhov, brazgotine bronhialne stene in pigmentne sluznice. Od pozitivnih bakterioloških izvidov je pri bronhoskopiji najpogostejši bronhialni izpirek. Test pomnoževanja nukleinskih kislin je pozitiven pri 45% vseh bolnikov, specifičnost pa je 100%. Z bronhoskopom lahko prenesemo BT tudi na druge bolnike, zato je nujno, da dosledno upoštevamo priporočila proizvajalca glede razkuževanja in pred tem temeljito mehansko očistimo bronhoskop. Osebje se pred prenosom okužbe s kužnim aerosolom zaščiti s posebnimi maskami in temeljitim zračenjem prostora.
Descriptors     TUBERCULOSIS, PULMONARY
BRONCHOSCOPY