Chest physiotherapy for collecting sputum samples from HIV-positive patients suspected of having tuberculosis.
METHODS
A public referral hospital in Sao Paulo, Brazil.


OBJECTIVE
To evaluate chest physiotherapy as a means of obtaining sputum samples from human immunodeficiency virus (HIV) positive in-patients suspected of having pulmonary tuberculosis (TB).


METHODS
A prospective study.


METHODS
Five consecutive samples were collected from 132 patients using the 'spontaneous' technique (ST) on day 1, slow expiration with the glottis open in a lateral posture ('expiration lente totale glotte ouverte en infralatéral', ELTGOL) on day 2, ST on day 3, sputum induction with hypertonic saline (SIHS) on day 4 and ST on day 5. Samples were processed for acid-fast bacilli (AFB) smear and seeded onto Löwenstein-Jensen medium.


RESULTS
Mycobacteria were recovered from 34 patients (25.8%). Nine (26.5%) of the strains were identified as mycobacteria other than Mycobacterium tuberculosis. AFB smear sensitivity was higher in ELTGOL samples than in ST or SIHS samples (52.9% vs. 32.4% and 29.4%), although the difference among the three was not significant (P = 0.098). In culture, the three ST samples proved significantly more sensitive (P = 0.05).


CONCLUSIONS
Physiotherapy shows promise as a technique for obtaining sputum from HIV-positive patients, and AFB testing of a single sample presents high sensitivity. However, this does not preclude the routine collection of three samples, as TB cannot be ruled out before the culture results are known.
Task Force of National Tuberculosis Control Programme for Sao Paulo State, Ministry of Health, Sao Paulo, Brazil; Emilio Ribas Institute for Infectious Diseases, Sao Paulo, Sao Paulo, Brazil. valdirpinto@uol.com.br
V
V
Souza Pinto
R H
RH
Bammann
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*