A physcian from Florida recently asked how one should approach the following. A younger man from a TB-endemic area with cavitary upper lobe lesions. He is not productive of sputum. Obviously, the physician elected to treat empirically for TB. In terms of getting sensitivities, a BAL should be done, but his question was, how long after initiation of 4-drug therapy would the BAL give a false positive. By false positive, I guess you could view that as as either afb negative, or culture negative (if the former represents dead TB bugs).
He was considering waiting 2 weeks to help decrease the risk to those in the bronchoscopy suite.
What do you think?
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it is mentioned after starting ATT, within 48 to 72 hrs most of the bacilli are dead provided we are dealing with a drug sensitive bacillus. However,this patient who comes from an endemic area, might be a drug resistant bacillus. In such a case waiting for 2 weeks would not really make much difference. In my opinion before starting ATT respiratory sample should be sent for sensitivity testing.
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