Morse M, Kessler J, Albrecht S, Kim R, Thakur R, Nthobatsang R, Radisowa K, Maunatlala C, Yang W, Macgregor R R, Friedman H
Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6073, USA.
Int J Tuberc Lung Dis. 2008 Nov;12(11):1279-85.
Low sensitivity of acid-fast bacilli (AFB) sputum smears and absence of productive cough are obstacles to the diagnosis of pulmonary tuberculosis (PTB) in hospitals that lack access to bronchoscopy.
To evaluate induced sputum, gastric content, blood and urine specimens to improve PTB diagnosis in patients not diagnosed by expectorated sputum AFB smears.
Patients admitted to the medical wards of a large public hospital in Gaborone, Botswana, were prospectively enrolled if they had symptoms consistent with PTB, an abnormal chest radiograph, were treated empirically with anti-tuberculosis chemotherapy or had no improvement on antibiotics, and had a non-productive cough or AFB smear-negative sputum. Induced sputum was stained for AFB and Mycobacterium tuberculosis cultures were performed on induced sputum, gastric contents, urine and blood.
Of 140 patients meeting the enrollment criteria, 113 (81%) were human immunodeficiency virus (HIV) positive. Fifty-seven (41%) had PTB based on positive cultures from one or more sites, including 48 (84%) from induced sputum, 17 (30%) urine, 13 (23%) gastric contents and 7 (12%) blood. AFB smears were positive in only 18 (32%) culture-proven PTB cases.
Induced sputum cultures greatly enhanced M. tuberculosis detection in patients with a high prevalence of HIV/AIDS in a hospital without access to bronchoscopy.
在缺乏支气管镜检查条件的医院中，痰涂片抗酸杆菌（AFB）检测灵敏度低以及无咳痰是肺结核（PTB）诊断的障碍。
评估诱导痰、胃内容物、血液和尿液标本，以改善痰涂片AFB检测未确诊患者的PTB诊断。
前瞻性纳入博茨瓦纳哈博罗内一家大型公立医院内科病房的患者，这些患者有与PTB相符的症状、胸部X线片异常、接受过抗结核化疗经验性治疗或使用抗生素后无改善，且有干咳或痰涂片AFB阴性。对诱导痰进行AFB染色，并对诱导痰、胃内容物、尿液和血液进行结核分枝杆菌培养。
140例符合纳入标准的患者中，113例（81%）人类免疫缺陷病毒（HIV）阳性。57例（41%）根据一个或多个部位培养阳性诊断为PTB，其中48例（84%）来自诱导痰，17例（30%）来自尿液，13例（23%）来自胃内容物，7例（12%）来自血液。仅18例（32%）培养确诊的PTB病例痰涂片AFB阳性。
在一家无法进行支气管镜检查的医院中，诱导痰培养大大提高了HIV/AIDS高流行率患者结核分枝杆菌的检出率。
