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Simple measures are as effective as invasive techniques in the diagnosis of pulmonary tuberculosis in Malawi

Bell, David J., Dacombe, Russell ORCID: https://orcid.org/0000-0002-6705-1537, Graham, S. M., Hicks, A., Cohen, D., Chikaonda, T., French, Neil, Molyneux, Malcolm E, Zijlstra, E. E., Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116 (2009) 'Simple measures are as effective as invasive techniques in the diagnosis of pulmonary tuberculosis in Malawi'. International Journal of Tuberculosis and Lung Disease, Vol 13, Issue 1, pp. 99-104.

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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.

Item Type: Article
Additional Information: 388HM Times Cited:0 Cited References Count:16
Uncontrolled Keywords: induced sputum gastric washings physiotherapy bal hiv sputum induction high prevalence smear hiv microscopy improve lavage area
Subjects: WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
QY Clinical Pathology > Diagnostic Tests > QY 120 Sputum
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > WF 100 General works
QY Clinical Pathology > QY 4 General works
WF Respiratory System > Tuberculosis > WF 205 Epidemiology
WF Respiratory System > Tuberculosis > WF 300 Pulmonary tuberculosis
WF Respiratory System > Tuberculosis > WF 310 Therapy
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Depositing User: Helen Rigby
Date Deposited: 26 Mar 2010 16:41
Last Modified: 06 Feb 2018 12:59
URI: http://archive.lstmed.ac.uk/id/eprint/230

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