Suspected pulmonary tuberculosis in rural South Africa--sputum induction as a simple diagnostic tool?
S Afr Med J 2002;
92:455-8. [PMID:
12146131]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES
To assess the value of sputum induction (SI) as a diagnostic tool for patients with suspected pulmonary tuberculosis (PTB) who are unable to expectorate or who have a negative sputum smear.
DESIGN
Study of an inpatient cohort undergoing SI.
SETTING
Mseleni Hospital, a rural district hospital in northern KwaZulu-Natal.
SUBJECTS
All adult patients with suspected TB seen at the hospital over a 4-month period.
OUTCOME MEASURES
(i) Successful SI; (ii) sputum acid-fast smear result; (iii) change of admission diagnosis as a result of the induction procedure; and (iv) number of patients discharged with a diagnosis other than TB who represented within 4 months with TB.
RESULTS
A total of 51 patients (31 female) underwent SI; of these 36 (71%) were able to produce a sputum sample. Fifteen (42%) of those were acid-fast smear-positive (29% of all patients included). The admission diagnosis was changed in 16 (44%) of the patients who were able to give an induced sputum sample as opposed to 4 (27%) who had been unable to expectorate despite an induction attempt (P = 0.38). Three (12.5%) of the 24 patients with a discharge diagnosis other than TB (17 pneumonia, 3 old TB, 2 carcinoma of the lung, 1 bronchiectasis) turned out to have TB within the follow-up period; 2 of those had extrapulmonary TB.
CONCLUSION
SI produced a positive smear result in 29% of patients with suspected TB who had previously been smear-negative or unable to expectorate. The method proved an aid to clinical decision making.
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