Tuberc Respir Dis.  2014 Apr;76(4):163-168.

Usefulness of Sputum Induction with Hypertonic Saline in a Real Clinical Practice for Bacteriological Yields of Active Pulmonary Tuberculosis

• Seong GM
• Lee J
• Lee JH
• Kim JH
• Kim M

Abstract

BACKGROUND
Mycobacterial identification in active pulmonary tuberculosis (APTB) is confirmative, even though successful rates using self-expectorated sputum are limited. Sputum specimens collected by hypertonic saline nebulization showed higher bacteriologic diagnostic sensitivities over those of self-expectoration, mostly studied in smear-negative or sputum-scarce patients. The efficacy of induced sputum was rarely assessed in real clinical settings.
METHODS
A prospective randomized case-control study was performed in one hospital. The subjects highly suspicious of APTB were asked to provide 3 pairs of sputum specimens in 3 consecutive days. The first pairs of the specimens were obtained either by self-expectoration (ES) from the next day of the visit or sputum induction with 7% saline nebulization in clinic (SI), and the other specimens were collected in the same way. The samples were tested in microscopy, culture, and polymerase chain reaction (PCR). The outcomes of the bacteriological diagnosis were compared.
RESULTS
Seventy six patients were assigned to either ES (38 subjects, median age of 51, 65.8% male) or SI (38 subjects, median age of 55, 52.6% male). APTB was clinically confirmed in 51 patients (70.8%), 27 in ES and 24 in SI. Among the APTB, more adequate specimens were collected from SI (41/65, 63.1%) than ES (34/80, 42.5%) (p=0.01). Bacteriological confirmation was achieved in 14 (58.3%) patients in SI, and 13 (48.1%) in ES (p=0.46). In the same-day bacteriological diagnosis with microscopy and PCR, there were positive results for 9 patients (37.5%) in SI and 7 patients (25.9%) in ES (p=0.37).
CONCLUSION
Sputum induction improves sputum specimen adequacy. It may be useful for the same-day bacteriological diagnosis with microscopic examination and PCR.

Keyword

Tuberculosis, Pulmonary; Saline Solution, Hypertonic; Sputum; Diagnosis

MeSH Terms

Case-Control Studies
Diagnosis
Humans
Microscopy
Polymerase Chain Reaction
Prospective Studies
Saline Solution, Hypertonic
Sputum*
Tuberculosis, Pulmonary*
Saline Solution, Hypertonic

Figure

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  Figure 1 A scheme of the study. APTB: active pulmonary tuberculosis; AFB: acid-fast bacilli; MTB: Mycobacterium tuberculosis; NTM: nontuberculous mycobacterium; PCR: polymerase chain reaction; ER, emergency room.

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  Figure 2 The incidence of bacteriological yields in self-expectoration and sputum-induction groups. New positive cases were counted by excluding the positive cases from the previous day's samples. AFB: acid-fast bacilli; PCR: polymerase chain reaction.

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  Figure 3 The proportions of the 1st day's bacteriological yields among active pulmonary tuberculosis (APTB)-confirmed cases according to the collection method. AFB: acid-fast bacilli; PCR: polymerase chain reaction.

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