title: Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis.
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.
authors.affiliation: Department of Medicine, Montreal Chest Institute, McGill University, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Anderson
authors.forename: N
authors.initials: N
authors.lastname: Inhaber
authors.forename: D
authors.initials: D
authors.lastname: Menzies
mesh_terms: D000328:Adult; D001999:Bronchoscopy / Q000191:economics / Q000379:methods; D002170:Canada; D003365:Costs and Cost Analysis; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D055100:Optical Fibers; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D013183:Sputum / Q000187:drug effects / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics
chemical_list: D012462:Saline Solution, Hypertonic