TITLE

The Efficient Diagnosis of Tuberculosis

AUTHOR(S)
Deresinski, Stan
PUB. DATE
September 2007
SOURCE
Travel Medicine Advisor;Sep2007, Vol. 17 Issue 9, p52
SOURCE TYPE
Periodical
DOC. TYPE
Article
ABSTRACT
Brown and colleagues evaluated the most efficient means of microbiological diagnosis of tuberculosis in patients. Adults in whom the presence of pulmonary tuberculosis was suspected based on the presence of compatible abnormalities on chest X-ray who were unable to produce an expectorated sputum sample were evaluated in order to determine the relative value of specimens obtained by sputum induction, gastric washing, and bronchoalveolar lavage (BAL). Also studied was the relative value of sputum induction on 3 consecutive days as opposed to obtaining all 3 samples on the same day, approximately 4 hours apart. Three induced sputum specimens were obtained on a single day, followed by additional morning samples on 2 subsequent days. Analysis of the 79 patients from whom all 5 samples were obtained found that at least one of the 3 specimens collected on a single day were positive in 27 (34%) of patients compared to a positive result in 29 (37%; P = 0.63) in at least one of the 3 daily induced sputum specimens. There was no correlation between the volume of sputum obtained for testing and the results. Twenty-one patients whose smears were negative underwent bronchoscopy, and BAL cultures proved to be positive in 5 (24%) -but all 5 had positive day-one induced sputum cultures. In addition, 2 individuals with positive day-one induced sputum samples had negative BAL cultures. At least 3 induced sputum specimens and 3 gastric washing specimens were available for 107 of the 140 patients enrolled; Mycobacterium tuberculosis was recovered in culture from one or more cultures obtained from 46 (43%) of the 107. At least one of the first 3 induced sputum samples obtained were culture positive in 42 (39%) patients compared to gastric washings from 32 (30%; P = 0.03) patients.
ACCESSION #
26599673

 

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