Radiographic anomalies compatible with tuberculosis found during screening are a poor guide to initiation of treatment. Respiratory and systemic symptoms correlated weakly with culture confirmation of tuberculosis. All radiologically selected cases must be examined with on-the-spot and early-morning sputum, regardless of symptoms. If both specimens are smear negative, the yield is increased by bronchoscopy and, to a lesser extent, by two samples of induced sputum. The examination of any single specimen has a low yield of 36 to 63% and is insufficient to exclude active tuberculosis.

At present, further investigations are needed in patients with suspected pulmonary tuberculosis (TB) and either negative sputum smear or without sputum. The aim of the present study was to analyse the yield of bronchoalveolar lavage fluid (BALF) smear and PCR in patients with confirmed pulmonary TB.Patients with a positive culture for Mycobacterium tuberculosis complex in sputum or BALF were analysed over 5 yrs.In total, 90 out of 230 (39%) patients with culture-positive pulmonary TB had a positive sputum smear, and 120 patients underwent bronchoscopy. BALF smear was positive in 56 (47%), BALF PCR in 93 (78%) patients, and BALF smear and/or PCR was positive in 83%. In total, 71 patients who underwent bronchoscopy and had complete clinical records were further analysed. BALF (smear or Mycobacterium tuberculosis complex-PCR) allowed a rapid diagnosis in 10 (59%) out of 17 patients who had a negative sputum smear, and 49 (91%) out of 54 patients without sputum production. Of these 71 patients, 12 (17%) were only culture positive. Rapid diagnosis of pulmonary TB by smear and/or PCR was made in 190 out of 210 patients (90%) in sputum or BALF.In conclusion, combined use of bronchoalveolar lavage fluid smear and Mycobacterium tuberculosis complex-PCR has a good diagnostic yield in patients with sputum smear-negative tuberculosis or without sputum production.

Background: The 6-min walk test (6MWT) is frequently used to assess overall cardiopulmonary fitness and to predict outcome, but it yields little diagnostic information. Portable telemetric devices allow performing the 6MWT with real-time cardiopulmonary monitoring. Objectives: The study was designed to analyze feasibility, safety and clinical usefulness of a mobile cardiopulmonary monitoring (MOB)-enhanced 6MWT. Methods: From August 2003 to June 2007, 261 consecutive patients with chronic lung and/or heart disease as well as healthy controls underwent MOB-enhanced 6MWTs. A subgroup of 33 individuals had the test done with and without cardiopulmonary monitoring on independent days. Results: No test-related adverse events occurred throughout the study. Whether the 6MWT was done without or with cardiopulmonary monitoring (n = 33) did not significantly influence the walking distance (WD: 528 ± 183 vs. 525 ± 192 m; nonsignificant). Fifty-nine percent (155/261) of the patients fulfilled the maximal test criteria. Distinct disease-specific exercise response patterns as well as treatable co-pathologies were observed. The validity of response patterns was better in case of a maximal test. Conclusion: An MOB-enhanced 6MWT is feasible within daily routine and safe in patients with various diseases. It does not negatively affect WD. MOB is a valuable tool to identify factors limiting exercise in patients irrespective of their underlying disease.