The Use of Hypertonic Aerosol in Production of Sputum for Diagnosis of Tuberculosis

Hensler, Nestor M.; Spivey, Charles G.; Dees, Tom M.

doi:10.1378/chest.40.6.639

Cited by 32 publications

(20 citation statements)

References 3 publications

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“…The technique of sputum induction with hypertonic saline was introduced 140 years ago [1]. Early studies demonstrated evidence of enhanced performance relative to the GW procedure; however, recent outbreaks of multidrug-resistant TB associated with its use in infectious diseases units have discouraged some clinicians from using this method [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…These methods vary in their tolerability, in their safety, and, notably, in their resource implications; bronchoscopy may not be feasible if large numbers of patients are involved, and it may not even be necessary if smearpositive specimens have been obtained by other, less invasive methods. Evidence of the relative diagnostic yield of each technique varies, although recent studies suggest that IS performs as well as BAL [1][2][3][4][5][6][7][8][9][10][11][12]. There are limited data on the number of IS samples required, the optimum volume of the sample for mycobacterial culture, and (most importantly) the timing of speci- Table 1.…”

mentioning

confidence: 99%

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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

Brown¹,

Varia²,

Bassett³

et al. 2007

Clinical Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Brown¹,

Varia²,

Bassett³

et al. 2007

Clinical Infectious Diseases

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“…SI was performed using saline concentrations ranging from 3 to 20% (median 3%, IQR 3-10), using a variety of ultrasonic nebulizers or conventional air compressors, and varying duration of saline nebulization (data incomplete). Eight studies (47%) compared SI to gastric lavage [13,[22][23][24][25][26], six studies (35%) to FOB [12,14,[27][28][29], three studies (18%) to spontaneous expectorated sputum [29][30][31], three studies (18%) compared SI to other invasive procedures, including the string test, lymph node biopsy, and nasopharyngeal aspiration [32][33][34], and two studies (12%) compared three diagnostic procedures (SI, spontaneous sputum, and FOB in one publication [31], and SI, gastric lavage, and FOB in the other [9]). …”

Section: Studies Recommended By Tuberculosis Experts N=12mentioning

confidence: 99%

Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis

Gonzalez-Angulo

Wiysonge

Geldenhuys

et al. 2011

Eur J Clin Microbiol Infect Dis

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Sputum induction (SI) has been proposed as the optimal sample collection method for patients with paucibacillary tuberculosis (TB). Studies reporting the culture of Mycobacterium tuberculosis from SI were reviewed. A random-effects meta-analysis of diagnostic yield (numerator M. tuberculosis SI culture-positive cases; denominator all culture-positive cases) was conducted. Diagnostic yields (95% confidence intervals, CIs) were displayed as Forest plots. Heterogeneity was evaluated using Chi-squared and I-squared tests and meta-regression analysis. Ninety publications were screened, 28 full-text papers reviewed, and 17 analyzed. Collectively, n=627 SI culture-positive cases among n=975 culture-confirmed TB cases were reported. The diagnostic yield of SI ranged from 35 to 95%. The pooled diagnostic yield was 74% (CI 65-81%), with significant heterogeneity (p<0.0001, I2=86%). There were no statistically significant differences in the yield between sub-groups defined by human immunodeficiency virus (HIV) prevalence or age. Univariate analysis demonstrated that the use of fiberoptic bronchoscopy (FOB) as the comparator method was associated with a 22% reduction (CI 2-42%) in the diagnostic yield of SI. However, after adjustment for confounding, the meta-regression analysis showed that FOB usage (p=0.21) and saline concentration (p=0.31) were not independently associated with the diagnostic yield. SI will detect approximately three-quarters of M. tuberculosis culture-positive cases under study conditions. Significant heterogeneity in the diagnostic yield was not explained by HIV prevalence, age, or the use of FOB as the comparator method. The use of a particular nebulized saline concentration for SI cannot be recommended on the basis of this meta-regression analysis.

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“…It has been found that patients with radiographic evidence and with smear negativity due to inability to expectorate adequate amount of sputum are left untreated which ultimately increases the burden of tuberculosis. Obtaining gastric washings, sputum induction done with hypertonic saline and fiberoptic bronchoscopy with bronchoalveolar lavage are established techniques for this indication, though these methods vary in their tolerability, safety and resource implications 3,4 . Sputum Induction is a safe and effective means of obtaining specimens for AFB smear and culture in persons suspected of having PTB but who cannot produce sputum spontaneously or who are smear-negative for AFB 5 .…”

Section: Introductionmentioning

confidence: 99%

Comparative study on effect of various induction methods on sputum smear positivity

Jethani

Kakkar

Semwal

et al. 2017

Bangladesh J Med Sci

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Abstract:Introduction: Under RNTCP, the diagnosis of 25-30% tuberculosis cases with negative bacteriological report with radiographic evidence and with smear negativity due to inability to expectorate adequate amount of sputum are left untreated which ultimately increases the burden of tuberculosis. Such cases can be subjected to induction methods to improve yield of positive result in sputum. Methodology: Study was undertaken on all 538 patients who attended the Chest and Tuberculosis department in DOTS Microscopy centre of HIMS. Intervention was done only in those found smear negative but clinically and radiologically suggestive of pulmonary tuberculosis who gave written consent i.e. = 92 subjects (Chest Physiotherapy (N=92); Nebulization (N=92) & Broncho-alveolar lavage (N=14). Results: Out 362 (67%) eligible subjects 228 were sputum negative, 92 patients gave consent for induction were subjected to chest physiotherapy for sputum induction of which 38 (41.3%) subjects came out to be sputum positive. Out of 92 patients subjected to nebulization for sputum induction 40 (43.4%) subjects yield sputum positive result. 14 patients were subjected to BAL (bronchoalveolar lavage) method to collect sputum sample of which 7(50%) came out to be sputum positive. (p=0.02). Conclusion: The non-invasive and cost effective methods of sputum induction should be incorporated more commonly in national programme as they provide better yield of sputum positivity.

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The Use of Hypertonic Aerosol in Production of Sputum for Diagnosis of Tuberculosis

Cited by 32 publications

References 3 publications

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

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

Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis

Comparative study on effect of various induction methods on sputum smear positivity

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