J Korean Med Sci.  2015 Jun;30(6):733-736. 10.3346/jkms.2015.30.6.733.

Acceptability of Sputum Specimens for Diagnosing Pulmonary Tuberculosis

• Lee YJ
• Shin S
• Roh EY
• Yoon JH
• Kim DK
• Chung HS
• Lee CH

• KMID: 2160601
• DOI: http://doi.org/10.3346/jkms.2015.30.6.733

Abstract

The evaluation of the quality of a sputum specimen prior to bacterial culture has been an accepted practice. However, optimal sputum criteria for pulmonary tuberculosis (TB) are not well established. We investigated indicators for sputum acceptability in tuberculosis cultures and acid-fast bacilli (AFB) smear. A post-hoc analysis of a randomized trial with 228 sputum specimens from 77 patients was conducted. In the trial, pulmonary TB suspects were requested for collecting three sputum specimens. We performed both TB study (AFB smear and M. tuberculosis culture) and Gram staining in each specimen. By using generalized estimating equations, the association between sputum characteristics and positive TB testings were analyzed. Although acceptable specimens for bacterial pneumonia showed higher TB-culture positive rates than unacceptable specimens (adjusted odds ratio [aOR]=1.66; 95% confidence interval [CI]=1.11-2.49), a specimen with > or =25 white blood cells/low-power field was the better predictor for positive M. tuberculosis cultures (aOR=2.30; 95% CI=1.48-3.58) and acid-fast bacilli smears (aOR=1.85; 95% CI=1.05-3.25). Sputum leukocytosis could be an indicator of sputum acceptability for diagnosing pulmonary tuberculosis.

Keyword

Acceptable Sputum; Tuberculosis, Pulmonary; Sputum WBC

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Bacteriological Techniques/*methods
Female
Humans
Male
Middle Aged
Mycobacterium tuberculosis/*isolation & purification
Reproducibility of Results
Sensitivity and Specificity
Sputum/cytology/*microbiology
Tuberculosis, Pulmonary/*diagnosis/*microbiology/pathology
Young Adult

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