Clinico-pathological Profile of Adult Bronchiectasis Patients at a North Indian Teaching Hospital

Background: Our teaching hospital receives a lot of referrals of patients with Bronchiectasis. We observed that Tuberculosis is considered a default etiology and prescribing anti-tubercular treatment a rule, by local general practioners. Aim: To investigate the cause of Bronchiectasis in patients presenting to our Out-patient clinic. Methods: 112 Bronchiectasis patients (labelled as tubercular etiology) were included on basis of chest-x-ray over 1 year period. All patients after taking thorough history & physical examinations underwent CT scan of thorax, sputum/BAL fluid for gram stain, cytology, AFB stain, mycobacterial culture, BAL fluid CD4/CD8 ratio, serological and microbiological tests for ABPA , Serum ACE levels, Spirometry, serum α-1 antitrypsin level. Results: CT scan showed involvement of Right lung in 34, Left lung in 58 with complete left lung in 22, complete right lung in 8, bilateral disease in 18 and right middle lobe in 2. At the end 98 cases were found to be tubercular etiology (76 inactive, 13 smear positive, 9 smear negative/ culture positive) of which 9 were Rifampicin resistant. 6 of 9 culture positives grew non-tubercular mycobacteria(NTM). 4 cases were diagnosed ABPA who were recieving ATT on Chest X-ray basis. 3 cases were diagnosed as Pulmonary sarcoidosis, 2 of which had received ATT in past. 1 case was diagnosed as Silicosis. Etiology in 6 cases could not be ascertained. Conclusion: Tuberculosis remains most common cause of bronchiectasis at our centre (87.5%). However other important causes should always be ruled out. Mycobacteria Culture and CBNAAT tests both must be performed to rule out reactivation of tuberculosis and NTM detection.