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?
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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