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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:, Graham, S. M., Hicks, A., Cohen, D., Chikaonda, T., French, Neil, Molyneux, Malcolm E, Zijlstra, E. E., Squire, Bertie ORCID: and Gordon, Stephen ORCID: (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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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: 17 Aug 2022 08:55


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