A controlled trial of sputum induction and routine collection methods for TB diagnosis in a South African community.
A controlled trial of sputum induction and routine collection methods for TB diagnosis in a South African community.
复制标题
DOI：
10.1007/s10096-014-2198-4
复制
发表时间：
2014-12
影响因子：
4.5
通讯作者：
Hatherill, M.
中科院分区：
文献类型：
--
作者：
Geldenhuys, H. D.;Whitelaw, A.;Tameris, M. D.;Van As, D.;Luabeya, K. K. A.;Mahomed, H.;Hussey, G.;Hanekom, W. A.;Hatherill, M.
尚未对所有疑似结核病患者（无论是否有自发咳痰能力）在首次接触卫生服务时进行痰诱导（SI）的肺结核诊断率进行评估。我们在南非社区环境中比较了SI的诊断率和常规痰液采集。疑似TB的门诊患者提供了“点”咳痰样本;通过高渗（5%）盐水雾化的SI样本;以及清晨咳痰样本。比较了SI和痰液样本之间痰涂片镜检和液体培养的诊断率（分母为所有结核分枝杆菌培养阳性的受试者）以及培养阳性的时间。555名受试者完成了SI程序，其中132名（24%）为HIV感染者。129份样本（23%）为M。结核培养阳性。与现场痰相比，SI（中位差异2天，p= 0.63）和清晨痰（中位差异2天，p= 0.02）的MGIT培养阳性时间更短。然而，对于所有受试者或HIV感染受试者，SI和点痰之间的培养阳性诊断率（差异为+0.7%; CI-7.0至+8.5%，p= 0.82）或SI和清晨痰之间的培养阳性诊断率（差异为+4.7%; CI-3.2至+12.5%，p= 0.20）没有差异。SI将时间减少到正M。结核菌培养，但不增加阳性培养率，相比常规痰收集。在高负担社区的门诊疑似结核病患者中，不能推荐SI作为首次接触的常规采集方法。
Diagnostic yield of pulmonary tuberculosis (TB) by sputum induction (SI) at first point of contact with health services, conducted in all patients with suspected TB regardless of ability to expectorate spontaneously, has not been evaluated. We compared diagnostic yield of SI to routine sputum collection in a South-African community setting. Ambulatory patients with suspected TB provided a ‘spot’ expectorated sputum sample; an SI sample by hypertonic (5%) saline nebulization; and early morning expectorated sputum sample. Diagnostic yield of sputum smear microscopy and liquid culture (denominator all subjects with any positive Mycobacterium tuberculosis culture), and time-to-positivity of culture were compared between SI and expectorated samples. 555 subjects completed the SI procedure, of whom 132 (24%) were HIV-infected. One-hundred-twenty-nine samples (23%) were M. tuberculosis culture positive. Time-to-positivity of MGIT culture was shorter for SI (median difference 2 days, p=0·63), and for early morning expectorated sputum (median difference 2 days, p=0·02), compared to spot expectorated sputum. However, there was no difference in culture-positive diagnostic yield between SI and spot expectorated sputum (difference +0.7%; CI −7.0 to +8.5%, p=0·82), or SI and early morning expectorated sputum (difference +4.7%; CI −3.2 to +12.5%, p=0·20) for all subjects; or for HIV-infected subjects. SI reduces time to positive M. tuberculosis culture, but does not increase the rate of positive culture, compared to routine expectorated sputum collection. SI cannot be recommended as the routine collection method at first contact among ambulatory patients with suspected TB in high burden communities.
登录
查看更多内容
DOI：
10.5588/ijtld.11.0614
发表时间：
2012-08
期刊：
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
影响因子：
--
作者：
Peter JG;Cashmore TJ;Meldau R;Theron G;van Zyl-Smit R;Dheda K
通讯作者：
Dheda K
DOI：
10.1016/s2213-2600(13)70120-6
发表时间：
2013-08
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Peter JG;Theron G;Pooran A;Thomas J;Pascoe M;Dheda K
通讯作者：
Dheda K
影响因子：
168.9
作者：
Zar, HJ;Honslo, D;Hussey, G
通讯作者：
Hussey, G
DOI：
10.1007/s10096-011-1344-5
发表时间：
2012-04-01
影响因子：
4.5
作者：
Geldenhuys, H. D.;Kleynhans, W.;Hatherill, M.
通讯作者：
Hatherill, M.
影响因子：
1.6
作者：
Saglam, L;Akgun, M;Aktas, E
通讯作者：
Aktas, E