A description of the profile of the patients and outcomes of fiber-optic bronchoscopies, performed at a tertiary care hospital in KwaZulu-Natal, South Africa, from January to December 2011.
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Date
2014
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Abstract
Background
Tuberculosis (TB), pneumonia and human immunodeficiency virus (HIV) were the three leading causes of natural deaths in South Africa in 2013 and 11.9% of all deaths in KwaZulu Natal were attributed to TB. In 2013, there was an estimated 5.26 million people infected with HIV in South Africa. HIV infected individuals have an increased risk of respiratory tract infections including smear negative TB. Lung cancer is the most common type of cancer in the world. However, due to infrequent updates of the cancer registry in South Africa, current prevalence is unknown. Bronchoscopy is a useful tool for the diagnosis of broncho-respiratory pathology.
Aims and Objectives
This study describes the patient profile and outcomes of bronchoscopy in a tertiary centre in KwaZulu Natal in 2011. Specific objectives were to describe bronchoscopy indications, microbiological, cellular and histological findings and prevalence of TB amongst smear negative patients by broncho-alveolar lavage (BAL). In addition, the common types of lung cancer diagnosed on biopsy during bronchoscopy were to be described.
Background
Tuberculosis (TB), pneumonia and human immunodeficiency virus (HIV) were the three leading causes of natural deaths in South Africa in 2013 and 11.9% of all deaths in KwaZulu Natal were attributed to TB. In 2013, there was an estimated 5.26 million people infected with HIV in South Africa. HIV infected individuals have an increased risk of respiratory tract infections including smear negative TB. Lung cancer is the most common type of cancer in the world. However, due to infrequent updates of the cancer registry in South Africa, current prevalence is unknown. Bronchoscopy is a useful tool for the diagnosis of broncho-respiratory pathology.
Aims and Objectives
This study describes the patient profile and outcomes of bronchoscopy in a tertiary centre in KwaZulu Natal in 2011. Specific objectives were to describe bronchoscopy indications, microbiological, cellular and histological findings and prevalence of TB amongst smear negative patients by broncho-alveolar lavage (BAL). In addition, the common types of lung cancer diagnosed on biopsy during bronchoscopy were to be described.
Background
Tuberculosis (TB), pneumonia and human immunodeficiency virus (HIV) were the three leading causes of natural deaths in South Africa in 2013 and 11.9% of all deaths in KwaZulu Natal were attributed to TB. In 2013, there was an estimated 5.26 million people infected with HIV in South Africa. HIV infected individuals have an increased risk of respiratory tract infections including smear negative TB. Lung cancer is the most common type of cancer in the world. However, due to infrequent updates of the cancer registry in South Africa, current prevalence is unknown. Bronchoscopy is a useful tool for the diagnosis of broncho-respiratory pathology.
Aims and Objectives
This study describes the patient profile and outcomes of bronchoscopy in a tertiary centre in KwaZulu Natal in 2011. Specific objectives were to describe bronchoscopy indications, microbiological, cellular and histological findings and prevalence of TB amongst smear negative patients by broncho-alveolar lavage (BAL). In addition, the common types of lung cancer diagnosed on biopsy during bronchoscopy were to be described.
Methods
A retrospective review of consecutive bronchoscopies performed by the pulmonologist at a tertiary hospital in western KwaZulu Natal, between 1 January and 31 December 2011 was performed. A total of 107 patients met the inclusion criteria. Data was collected from clinical records, laboratory and radiology computerised record systems and entered on an Excel workbook using Microsoft Office 2010® software. Data was analysed using Epi-Info Version 3.5.4® and Stata/IC 13.0®. The demographic, bronchoscopy and chest CT scan findings were summarised with descriptive summary measures and expressed as means ± standard deviation (SD) and/or medians with the range and interquartile range for quantitative variables. Percentages, frequencies and proportions were used to describe categorical variables.
Results
The median age of patients was 55 ± 14.4 (Interquartile range (IQR) 43 - 63) years and 68 (63.6%) patients were male. Twenty-eight (26.2%) patients were HIV infected with a median cluster of differentiation 4 count of 254 ±164 (IQR 126 – 366.5) cells per cubic millimetre. Nine patients were on antiretroviral therapy.
The commonest indications for bronchoscopy were investigation of a lung mass (35.8%), non-resolving lower respiratory tract infection (15%) and suspected TB (15%). Microbiological findings on BAL samples included gram positive and negative bacteria (14%) and fungi (20%). TB microscopy, polymerase chain reaction and culture revealed mycobacterium tuberculosis on 22.2% of all BAL samples. Two patients with mycobacterium tuberculosis on BAL samples were HIV infected. The prevalence of TB on smear negative patients was 11.1%. Cytological analysis of BAL samples detected pathology on eight (13.1%) patients and two (3.3%) of these patients had lung cancer. Malignant (52.9%) (squamous cell carcinoma and adenocarcinoma) and benign (11.1%) (pneumonia and interstitial fibrosis) pathology was found on histology. Squamous cell carcinoma (37%) was the commonest lung cancer detected.
Bronchoscopy was helpful in determining broncho-respiratory pathology in 38 (35.5%) patients. The commonest diagnosis was lower respiratory tract infection in 7 of 15 (46.7%) patients referred with diffuse pulmonary infiltrates. Bronchoscopy also assisted with the diagnosis of lung cancer in 20 of 43 (46.5%) patients referred with suspected lung mass. Overall the procedure complication rate was 3.7%.
Conclusion
Bronchoscopy may be a useful tool in diagnosing and decreasing the morbidity associated with respiratory illness in South Africa as the diagnostic yield was greatest for lower respiratory tract infections. Samples collected during BAL had a relatively low diagnostic yield for TB. Prompt referral of smear negative TB suspects is recommended to assist with the microbiological diagnosis of TB and direct therapy thereof.
Cytological examination of BAL samples was associated with a low yield of lung cancer and biopsy samples were more useful for this purpose. SCC was the commonest histological subtype of lung cancer in this cohort. Bronchoscopy was a relatively safe procedure in determining the aetiology of broncho-respiratory pathology.
Description
Master of Medicine in Internal Medicine. University of KwaZulu-Natal. Durban, 2014.