Multiple microbiologic tests for tuberculosis improve diagnostic yield of bronchoscopy in medically complex patients

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Globally, tuberculosis (TB) is the ninth leading cause of mortality with an estimated 1.6 million deaths reported in 2016. In 2011, the World Health Organization (WHO) recommended the GeneXpert MTB/RIF assay (Cepheid, Sunnyvale, CA, USA), a TB polymerase chain reaction (PCR) based test as the initial investigation of choice in patients with human immunodeficiency virus (HIV) co-infection or presumed multidrug resistant (MDR) TB. Few data exist to guide the use of Xpert MTB/Rif on bronchoalveolar lavage (BAL) specimens. Xpert MTB/RIF has been evaluated in BAL specimens from individuals with presumed TB who are sputum scarce or smear negative and has been shown to outperform smear microscopy in both high and low TB burden regions. In our public-sector based pulmonology clinic in urban South Africa, diagnostic bronchoscopy is used to evaluate medically complex patients for a variety of respiratory presentations occurring in the background of high rates of HIV and TB endemicityn ...