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.
Souza Pinto
V
V
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
Bammann
R H
RH
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*