Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2002 Dec;57(12):1010–1014. doi: 10.1136/thorax.57.12.1010

Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis

T McWilliams 1, A Wells 1, A Harrison 1, S Lindstrom 1, R Cameron 1, E Foskin 1
PMCID: PMC1758793  PMID: 12454293

Abstract

Background: Previous studies suggest that bronchoscopy and a single induced sputum sample are equally effective for diagnosing pulmonary tuberculosis.

Methods: In a prospective study of subjects with possibly active pulmonary tuberculosis, the diagnostic yield of three induced sputum tests was compared with that of bronchoscopy. Subjects either produced no sputum or (acid fast) smear negative sputum. Bronchoscopy was only performed if at least two induced sputum samples were smear negative.

Results: Of 129 subjects who completed all tests, 27 (21%) had smear negative and culture positive specimens, 14 (52%) on bronchoscopy and 26 (96%) on induced sputum (p<0.005). One patient was culture positive on bronchoscopy alone compared with 13 on induced sputum alone; 13 were culture positive on both tests. Induced sputum positivity was strikingly more prevalent when chest radiographic appearances showed any features of active tuberculosis (20/63, 32%) than when appearances suggested inactivity (1/44, 2%; p<0.005). Induced sputum costs were about one third those of bronchoscopy, and the ratio of costs of the two tests per case of tuberculosis diagnosed could be as much as 1:6.

Conclusions: In subjects investigated for possibly active or inactive tuberculosis who produce no sputum or have smear negative sputum, the most cost effective strategy is to perform three induced sputum tests without bronchoscopy. Induced sputum testing carries a high risk of nosocomial tuberculosis unless performed in respiratory isolation conditions. The cost benefits shown could be lost if risk management measures are not observed.

Full Text

The Full Text of this article is available as a PDF (110.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Al Zahrani K., Al Jahdali H., Poirier L., René P., Menzies D. Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2001 Sep;5(9):855–860. [PubMed] [Google Scholar]
  2. Anderson C., Inhaber N., Menzies D. Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis. Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1570–1574. doi: 10.1164/ajrccm.152.5.7582296. [DOI] [PubMed] [Google Scholar]
  3. Bhowmik A., Seemungal T. A., Sapsford R. J., Devalia J. L., Wedzicha J. A. Comparison of spontaneous and induced sputum for investigation of airway inflammation in chronic obstructive pulmonary disease. Thorax. 1998 Nov;53(11):953–956. doi: 10.1136/thx.53.11.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Campagnaro R. L., Teichtahl H., Dwyer B. A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and autocleaner. Aust N Z J Med. 1994 Dec;24(6):693–695. doi: 10.1111/j.1445-5994.1994.tb01785.x. [DOI] [PubMed] [Google Scholar]
  5. Charoenratanakul S., Dejsomritrutai W., Chaiprasert A. Diagnostic role of fiberoptic bronchoscopy in suspected smear negative pulmonary tuberculosis. Respir Med. 1995 Oct;89(9):621–623. doi: 10.1016/0954-6111(95)90231-7. [DOI] [PubMed] [Google Scholar]
  6. Conde M. B., Soares S. L., Mello F. C., Rezende V. M., Almeida L. L., Reingold A. L., Daley C. L., Kritski A. L. Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis: experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil. Am J Respir Crit Care Med. 2000 Dec;162(6):2238–2240. doi: 10.1164/ajrccm.162.6.2003125. [DOI] [PubMed] [Google Scholar]
  7. Danek S. J., Bower J. S. Diagnosis of pulmonary tuberculosis by flexible fiberoptic bronchoscopy. Am Rev Respir Dis. 1979 Apr;119(4):677–679. doi: 10.1164/arrd.1979.119.4.677. [DOI] [PubMed] [Google Scholar]
  8. Davis D., Bonekat H. W., Andrews D., Shigeoka J. W. Disinfection of the flexible fibreoptic bronchoscope against Mycobacterium tuberculosis and M gordonae. Thorax. 1984 Oct;39(10):785–788. doi: 10.1136/thx.39.10.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dawson D. J., Armstrong J. G., Blacklock Z. M. Mycobacterial cross-contamination of bronchoscopy specimens. Am Rev Respir Dis. 1982 Dec;126(6):1095–1097. doi: 10.1164/arrd.1982.126.6.1095. [DOI] [PubMed] [Google Scholar]
  10. Fishman J. A., Roth R. S., Zanzot E., Enos E. J., Ferraro M. J. Use of induced sputum specimens for microbiologic diagnosis of infections due to organisms other than Pneumocystis carinii. J Clin Microbiol. 1994 Jan;32(1):131–134. doi: 10.1128/jcm.32.1.131-134.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fraser V. J., Jones M., Murray P. R., Medoff G., Zhang Y., Wallace R. J., Jr Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfection machine. Am Rev Respir Dis. 1992 Apr;145(4 Pt 1):853–855. doi: 10.1164/ajrccm/145.4_Pt_1.853. [DOI] [PubMed] [Google Scholar]
  12. Jett J. R., Cortese D. A., Dines D. E. The value of bronchoscopy in the diagnosis of mycobacterial disease. A five-year experience. Chest. 1981 Nov;80(5):575–578. doi: 10.1378/chest.80.5.575. [DOI] [PubMed] [Google Scholar]
  13. Larson J. L., Ridzon R., Hannan M. M. Sputum induction versus fiberoptic bronchoscopy in the diagnosis of tuberculosis. Am J Respir Crit Care Med. 2001 Apr;163(5):1279–1280. doi: 10.1164/ajrccm.163.5.1635f. [DOI] [PubMed] [Google Scholar]
  14. Leers W. D. Disinfecting endoscopes: how not to transmit Mycobacterium tuberculosis by bronchoscopy. Can Med Assoc J. 1980 Aug 23;123(4):275-80, 283. [PMC free article] [PubMed] [Google Scholar]
  15. Li L. M., Bai L. Q., Yang H. L., Xiao C. F., Tang R. Y., Chen Y. F., Chen S. M., Liu S. S., Zhang S. N., Ou Y. H. Sputum induction to improve the diagnostic yield in patients with suspected pulmonary tuberculosis. Int J Tuberc Lung Dis. 1999 Dec;3(12):1137–1139. [PubMed] [Google Scholar]
  16. Merrick S. T., Sepkowitz K. A., Walsh J., Damson L., McKinley P., Jacobs J. L. Comparison of induced versus expectorated sputum for diagnosis of pulmonary tuberculosis by acid-fast smear. Am J Infect Control. 1997 Dec;25(6):463–466. doi: 10.1016/s0196-6553(97)90068-7. [DOI] [PubMed] [Google Scholar]
  17. Nelson K. E., Larson P. A., Schraufnagel D. E., Jackson J. Transmission of tuberculosis by flexible fiberbronchoscopes. Am Rev Respir Dis. 1983 Jan;127(1):97–100. doi: 10.1164/arrd.1983.127.1.97. [DOI] [PubMed] [Google Scholar]
  18. Pappas S. A., Schaaff D. M., DiCostanzo M. B., King F. W., Jr, Sharp J. T. Contamination of flexible fiberoptic bronchoscopes. Am Rev Respir Dis. 1983 Mar;127(3):391–392. doi: 10.1164/arrd.1983.127.3.391a. [DOI] [PubMed] [Google Scholar]
  19. Parry C. M., Kamoto O., Harries A. D., Wirima J. J., Nyirenda C. M., Nyangulu D. S., Hart C. A. The use of sputum induction for establishing a diagnosis in patients with suspected pulmonary tuberculosis in Malawi. Tuber Lung Dis. 1995 Feb;76(1):72–76. doi: 10.1016/0962-8479(95)90583-9. [DOI] [PubMed] [Google Scholar]
  20. Pizzichini E., Pizzichini M. M., Efthimiadis A., Evans S., Morris M. M., Squillace D., Gleich G. J., Dolovich J., Hargreave F. E. Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):308–317. doi: 10.1164/ajrccm.154.2.8756799. [DOI] [PubMed] [Google Scholar]
  21. Schmidt R. M., Rosenkranz H. S. Antimicrobial activity of local anesthetics: lidocaine and procaine. J Infect Dis. 1970 Jun;121(6):597–607. doi: 10.1093/infdis/121.6.597. [DOI] [PubMed] [Google Scholar]
  22. Steere A. C., Corrales J., von Graevenitz A. A cluster of Mycobacterium gordonae isolates from bronchoscopy specimens. Am Rev Respir Dis. 1979 Jul;120(1):214–216. doi: 10.1164/arrd.1979.120.1.214. [DOI] [PubMed] [Google Scholar]
  23. Uddenfeldt M., Lundgren R. Flexible fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis. Tubercle. 1981 Sep;62(3):197–199. doi: 10.1016/0041-3879(81)90006-4. [DOI] [PubMed] [Google Scholar]
  24. Willcox P. A., Benatar S. R., Potgieter P. D. Use of the flexible fibreoptic bronchoscope in diagnosis of sputum-negative pulmonary tuberculosis. Thorax. 1982 Aug;37(8):598–601. doi: 10.1136/thx.37.8.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. van Embden J. D., Cave M. D., Crawford J. T., Dale J. W., Eisenach K. D., Gicquel B., Hermans P., Martin C., McAdam R., Shinnick T. M. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol. 1993 Feb;31(2):406–409. doi: 10.1128/jcm.31.2.406-409.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES