Prospective Study of Sputum Induction, Gastric Washing, and Bronchoalveolar Lavage for the Diagnosis of Pulmonary Tuberculosis in Patients Who Are Unable to Expectorate

Brown, M. W.; Varia, Hansa; Bassett, Paul; Davidson, Robert N.; Wall, R.A.; Pasvol, Geoffrey

doi:10.1086/516782

Cited by 90 publications

(83 citation statements)

References 20 publications

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“…19 The wide difference in yield between smear and culture, in contrast to our study, was probably due to patients having early disease with minimal changes on 20 In our study, although the samples were not neutralised, the contamination rate was significantly higher in specimens with >5 ml volume, presumably because of the fluid instilled before aspiration.…”

Section: Discussioncontrasting

confidence: 79%

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Aslam¹,

Tahseen²,

Schomotzer

et al. 2017

public health action

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Section: Discussioncontrasting

confidence: 79%

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Aslam¹,

Tahseen²,

Schomotzer

et al. 2017

public health action

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“…In accordance with the findings of previous studies, (10,11) we demonstrated that the yield of the culture is almost twice as high as the yield of AFB smear testing and confirmed the importance of culture in the diagnosis of pulmonary TB.…”

Section: Discussionsupporting

confidence: 92%

“…(7,8,(10)(11)(12)(13)(14)23,24) Anderson et al (8) compared a single IS sample with BAL specimens in HIV-negative patients and also reported low sensitivity for AFB smear testing using both techniques (19% and 12%, respectively), although the sensitivity of culture was 73% in IS and 87% in BAL fluid. Another group of authors (11) demonstrated higher sensitivity for AFB smear testing, comparing 3 IS samples with BAL specimens, and found no difference between HIV-negative and HIV-positive patients (34% and 36% for IS, and 38% and 40% for BAL fluid, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…However, the invasive nature of bronchoscopy, together with its higher cost, has motivated researchers to assess its yield in the diagnosis of pulmonary TB. (7)(8)(9)(10)(11)(12)(13)(14) The objective of our study was to assess the diagnostic sensitivity of the bacteriologic analysis of induced sputum (IS) for the diagnosis of pulmonary TB in a tertiary referral hospital in a region with a high prevalence of TB, as well as to identify the clinical characteristics associated with the confirmed diagnosis. In addition, we evaluated the diagnostic yield of bronchoscopy performed after IS samples have tested negative for AFB.…”

Section: Introductionmentioning

confidence: 99%

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Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

et al. 2009

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Objective: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. Methods: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. Results: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. Conclusions: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.Keywords: Tuberculosis, pulmonary; Diagnosis; Sputum. ResumoObjetivo: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI) para o diagnós-tico de tuberculose (TB) pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a pesquisa de BAAR for negativa no EI. Métodos: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. Resultados: Dos 417 pacientes estudados, 83 (19,9%) tiveram resultados positivos (BAAR e/ou cultura) no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95%: 1,9-7,6) e de infiltrado de padrão miliar (OR = 3,7; IC95%: 1,6-8,6) associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI...

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“…They are also aware that sputum smear microscopy is the simplest and cheapest technique for diagnosis. According to the WHO and IULTD recommendations, the use of BAL or sputum induction for the diagnosis of TB is only justified if the patient is unable to produce sufficient sputum for examination, or when 2-3 high quality early morning sputum samples have been smear negative and a high index of suspicion of pulmonary TB persists [7][8][9][10][11][12]. Gastric lavage is appropriate in children under 5 who are unable to produce sputum reliably [9,13,14].…”

Section: Discussionmentioning

confidence: 99%

The Use of Broncho-Alveolar or Gastric Lavage for the Diagnosis of Pulmonary Tuberculosis in Ouagadougou, Burkina Faso

Diandé¹,

Kolk²,

Moyenga³

et al. 2013

UCMS

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Background: the national and international guidelines of the WHO and the IUALTD recommend priority sputum smears for diagnosis of pulmonary tuberculosis. We studied the use and diagnostic yield of sputum, broncho-alveolar and gastric lavage (BAL, GL) in the reference national mycobacteria Laboratory (NRL) (Burkina Faso) to see if clinicians follow the recommendations in the prescription of specimens. Methods: We analyzed by microscopy all samples sent to the RNL from 8 public and 6 private health care facilities in 2010. Results: 2638 patients were included. We have reported on 2414 early morning sputum samples, BAL from 191 patients and gastric lavage from 33. There were significant differences in the type of sample submitted per institution. Sputum formed 95% of the 862 samples from one hospital, whereas 78% of the 223 samples submitted by one private clinic were BAL samples. No sputum samples were submitted from these patients and in this clinic the diagnostic yield of BAL was just 4%. The overall diagnostic yield for early morning sputum specimens was 12% (290/2414), for BAL 3.7% (7/191) and for GL 6% (2/33). Conclusion: there was considerable variation in the diagnostic procedure used. Invasive methods are used at some sites in preference to safer and simpler means of obtaining material for diagnosis. Our review shows the need for constant vigilance and close adherence to internationally accepted guidelines for the diagnosis of pulmonary TB.

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Prospective Study of Sputum Induction, Gastric Washing, and Bronchoalveolar Lavage for the Diagnosis of Pulmonary Tuberculosis in Patients Who Are Unable to Expectorate

Cited by 90 publications

References 20 publications

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

The Use of Broncho-Alveolar or Gastric Lavage for the Diagnosis of Pulmonary Tuberculosis in Ouagadougou, Burkina Faso

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