Perhimpunan Dokter Paru Indonesia - Exposure to mycobacterium tuberculosis during bronchoscopy in patients with unexpected pulmonary tuberculosis
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Exposure to mycobacterium tuberculosis during bronchoscopy in patients with unexpected pulmonary tuberculosis

Jung Seop Eom1, Geewon Lee2, Jeong Ha Mok1 and Min Ki Lee1
1Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea, 2Department of Radiology, Pusan National University School of MedicineRepublic of Korea

Background: Guidelines recommend the use by healthcare personnel of a fit-tested N95 particulate respirator when pulmonary tuberculosis (PTB) is suspected in a patient undergoing bronchoscopy. However, Mycobacterium tuberculosis (MTB) infection may be unsuspected in this setting and therefore not evaluated, resulting in the unexpected exposure to MTB by healthcare workers in the bronchoscopy suite.

Objectives: We examined the incidence of unexpected exposure to MTB during bronchoscopy and determined the exposure-related factors.

Methods: A retrospective study was conducted based on 1650 patients who underwent bronchoscopy for suspicious respiratory disease other than PTB. The results of bronchial washing, bronchoalveolar lavage, and post-bronchoscopic sputum were reviewed.

Results: PTB was unexpectedly diagnosed in 76 patients (4.6%). The presence of anthracofibrosis (OR, 3.878; 95% CI, 1.291?11.650; P = 0.016), bronchiectasis (OR, 1.974; 95% CI, 1.095?3.557; P = 0.024), or atelectasis (OR, 1.740; 95% CI, 1.010?2.903; P = 0.046) on CT was independently associated with unexpected PTB.

Conclusions: The risk of MTB exposure by healthcare personnel in the bronchoscopy suite due to patients with undiagnosed PTB has been underestimated. Therefore, higher-grade respiratory precaution should be considered in the bronchoscopic evaluation of patients with CT-confirmed anthracofibrosis, bronchiectasis, or atelectasis.

PP-PDPI. 12/05/17.

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