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Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis.

https://arctichealth.org/en/permalink/ahliterature214017
Source
Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1570-4
Publication Type
Article
Date
Nov-1995
Author
C. Anderson
N. Inhaber
D. Menzies
Author Affiliation
Department of Medicine, Montreal Chest Institute, McGill University, Canada.
Source
Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1570-4
Date
Nov-1995
Language
English
Publication Type
Article
Keywords
Adult
Bronchoscopy - economics - methods
Canada
Costs and Cost Analysis
Female
Fiber Optic Technology
Humans
Male
Mycobacterium tuberculosis - isolation & purification
Optical Fibers
Prospective Studies
Saline Solution, Hypertonic - administration & dosage
Sensitivity and specificity
Sputum - drug effects - microbiology
Tuberculosis, Pulmonary - diagnosis - economics
Abstract
Microbiologic confirmation of pulmonary tuberculosis among patients whose sputum smear is negative is increasingly important because of greater incidence among immunocompromised hosts and emergence of drug-resistant strains. We prospectively compared sputum induction to fiber-optic bronchoscopy in the diagnosis of such patients. Consecutive patients referred for investigation of possible active pulmonary tuberculosis underwent sputum induction with hypertonic saline delivered by an ultrasonic nebulizer between 2 and 48 h before transnasal fiber-optic bronchoscopy. All specimens were examined for acid-fast bacilli with fluorescent microscopy and cultured for mycobacteria. Clinical information was abstracted from patient records, and X-rays were reviewed by two blinded readers. Among 101 participants, sputum induction was well-tolerated without complications and provided adequate samples in 93. Sensitivity of direct acid-fast bacilli smear of specimens from both techniques was low. Sensitivity and negative predictive value of culture from bronchoscopy specimens was 73% and 91% compared with 87% and 96%, respectively, for sputum induction when a specimen was obtained. Direct costs for bronchoscopy totaled Canadian $187.60 compared with Canadian $22.22 for sputum induction. Sputum induction was well-tolerated, low-cost, and provided the same, if not better, diagnostic yield compared with bronchoscopy in the diagnosis of smear-negative pulmonary tuberculosis.
PubMed ID
7582296 View in PubMed
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