Authors: Bell, D.J.¹; Dacombe, R.²; Graham, S.M.³; Hicks, A.⁴; Cohen, D.⁵; Chikaonda, T.⁶; French, N.⁷; Molyneux, M.E.⁸; Zijlstra, E.E.⁵; Squire, S.B.⁹; Gordon, S.B.¹⁰

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 1, January 2009 , pp. 99-104(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Detection of smear-positive pulmonary tuberculosis (PTB) cases is vital for tuberculosis (TB) control. Methods to augment sputum collection are available, but their additional benefit is uncertain in resource-limited settings.

OBJECTIVE: To compare the diagnostic yields using five methods to obtain sputum from adults diagnosed with smear-negative PTB in Malawi.

DESIGN: Self-expectorated sputum was collected under supervision for microscopy and mycobacterial culture in the study laboratory. Confirmed smear-negative patients provided physiotherapy-assisted sputum and induced sputum, followed the next morning by gastric washing and bronchoalveolar lavage (BAL) samples.

RESULTS: A total of 150 patients diagnosed with smear-negative PTB by the hospital service were screened; 39 (26%) were smear-positive from supervised self-expectorated sputum examined in the study laboratory. The remaining 111 confirmed smear-negative patients were enrolled in the study; 89% were human immunodeficiency virus positive. Seven additional smear-positive cases were diagnosed using the augmented sputum collection techniques. No differences were observed in the numbers of cases detected using the different methods. Of the 46 smear-positive cases, 44 (95.6%) could be detected from self-expectorated and physiotherapy-assisted samples.

CONCLUSIONS: For countries such as Malawi, the best use of limited resources to detect smear-positive PTB cases would be to improve the quality of self-expectorated sputum collection and microscopy. The additional diagnostic yield using BAL after induced sputum is limited.

Keywords: induced sputum; gastric washings; physiotherapy; BAL; HIV

Document Type: Regular paper

Affiliations: 1: Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyra, Malawi 2: Liverpool Associates in Tropical Health, Liverpool School of Tropical Medicine, Liverpool, UK 3: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyra, Malawi; Centre for International Child Health, Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia 4: Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK 5: Department of Medicine, College of Medicine, University of Malawi, Blantyra, Malawi 6: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyra, Malawi 7: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyra, Malawi; Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK 8: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyra, Malawi; and Clinical Group, Liverpool School of Tropical Medicine, Liverpool, UK 9: Clinical Group, Liverpool School of Tropical Medicine, Liverpool, UK 10: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyra, Malawi; Pulmonary Immunology Group, Liverpool School of Tropical Medicine, Liverpool, UK

Publication date: 2009-01-01

More about this publication?

• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

  Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

• Editorial Board
• Information for Authors
• Subscribe to this Title
• ingentaconnect is not responsible for the content or availability of external websites

Related content

• In this: publication
• By this: publisher
• In this Subject: Internal Medicine
• By this author: Bell, D.J. ;  Dacombe, R. ;  Graham, S.M. ;  Hicks, A. ;  Cohen, D. ;  Chikaonda, T. ;  French, N. ;  Molyneux, M.E. ;  Zijlstra, E.E. ;  Squire, S.B. ;  Gordon, S.B.

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers