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ABSTRACT
Background. The early diagnosis of pulmonary tuberculosis is one of the most effective intervention in tuberculosis (TB) control strategy, but it is still facing a high proportion of smear negative sputum. We aimed to assess the yield and safety of sputum induction (SI) for pulmonary tuberculosis (PT) diagnosis, and to seek its positivity predictors, in adults with negative analysis of spontaneous sputum. Methods. Adults suspected to have pulmonary tuberculosis, and who had 2 consecutive negative acid fast bacilli (AFB) and Loop-mediated isothermal amplification (TB-LAMP), were invited to undergo a unique 10% hypertonic saline inhalation. Only consenting patients who were able to undergo the inhalation procedure safely were ultimately retained. The induced sputum was analyzed through auramine AFB smear and TB-LAMP test. Results. A total of 110 patients were selected. The AFB smear and TB-LAMP were positive for 12 patients (10.9%). Limiting the sample to patients with salivary spontaneous sputum, salivary sputum + nodules, and salivary sputum + cavities improved diagnosis yield to 18.9%, 32.0% and 62.5%, respectively. Predictors for a positive IS analysis [adjusted odds ratio (95% confident interval), P-value] were nodules [15.2 (1.8, 132.2), 0.002] and cavities [32.7 (3.2, 336.3), < 0.001]. The procedure induced 0.9 – 1.8% minor adverse events. Conclusion. Our results showed a low diagnosis yield and a good safety in this study. Selection of patients based on the type of spontaneous sputum and CXR significantly improved the diagnosis yield.
RÉSUMÉ
Introduction. Le diagnostic précoce de la tuberculose pulmonaire (TP) est une intervention majeure de contrôle de la tuberculose (TB). Cependant, il reste compromis par la proportion élevée d’analyse négative de l’expectoration. Cette étude évaluait le rendement et l’innocuité de l’expectoration induite (EI) pour le diagnostic de la TP, et recherchait les facteurs associés à sa positivité, chez des adultes présentant une analyse négative de l’expectoration spontanée. Méthodes. Une recherche de tuberculose était réalisée sur 2 expectorats par recherche de bacilles acido-alcoolo résistants (BAAR) et Loop-mediated isothermal amplification (TB-LAMP). Ceux présentant une recherche négative étaient invités à produire une expectoration induite par la nébulisation de chlorure de sodium à 10%. Seuls les patients consentants de participer et capables d’effectuer l’examen étaient retenus. Les analyses comportaient la microscopie à fluorescence (coloration à l’auramine) et le TB-LAMP. Résultats. Au total 110 patients ont été retenus. L’analyse de l’EI était positive pour 12 (10,9%) patients. L’expectorat spontané salivaire, et son association à des nodules pulmonaires ou des lésions cavitaires améliorait le rendement diagnostic à 18,9%, 32,0% et 62,5% respectivement. Les prédicteurs de positivité [rapport de cotes ajusté (intervalle de confiance à 95%), P-valeur] étaient la présence de lésions nodulaires [15,2 (1,8; 132,2), 0,002] et cavitaires [32,7 (3,2; 336,3), < 0,001]. La procédure a provoqué 0,9 à 1,8% d’effets secondaires mineurs. Conclusion. Le rendement de l’EI était faible et l’innocuité bonne chez les patients tout venant. L’expectoration salivaire et les lésions nodulaires ou cavitaires amélioreraient significativement ce rendement.
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References
- Organisation Mondiale de la Santé. Tuberculose [Internet]. [cited 2021 Mar 25]. Available from: https://www.who.int/fr/news-room/fact-sheets/detail/tuberculosis
- Shete PB, Farr K, Strnad L, Gray CM, Cattamanchi A. Diagnostic accuracy of TB-LAMP for pulmonary tuberculosis: a systematic review and meta-analysis. BMC Infect Dis. 2019;19(1):268.
- Bitchong Ekono CF, Mballa Amougou JC, Azoumbou Mefant T, Massongo Massongo, Issalne Palai Y, ZE JJ, et al. Profil Épidémio-Clinique, Paraclinique et Évolutif des Patients Traités pour Tuberculose à l’Hôpital Jamot de Yaoundé. Health Sci Dis [Internet]. 2018;19(4). Available from: www.hsd-fmsb.org
- Programme National de Lutte contre la Tuberculose. Guide technique pour les personnels de santé au Cameroun. 2019.
- Agbor AA, Bigna JJR, Billong SC, Tejiokem MC, Ekali GL, Plottel CS, et al. Factors associated with death during tuberculosis treatment of patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon: an 8-year hospital-based retrospective cohort study (2006-2013). PloS One. 2014;9(12):e115211.
- Yone EWP, Kengne AP, Kuaban C. Incidence, time and determinants of tuberculosis treatment default in Yaounde, Cameroon: a retrospective hospital register-based cohort study. BMJ Open. 2011;1(2):e000289.
- Balkissou AD, Poka-Mayap V, Massongo M, Pefura-Yone EW. Incidence et facteurs prédictifs de décès au cours de la tuberculose dans deux régions camerounaises. Rev Mal Respir Actual. 2021;13(1):230.
- Balkissou AD, Poka-Mayap V, Massongo M, Pefura-Yone EW. Facteurs prédictifs des perdus de vue au cours de la tuberculose dans deux régions camerounaises. Rev Mal Respir Actual. 2021;13(1):229–30.
- Park JS. Efficacy of Induced Sputum for the Diagnosis of Pulmonary Tuberculosis in Adults Unable to Expectorate Sputum. Tuberc Respir Dis. 2015;78(3):203–9.
- Lawn SD, Kerkhoff AD, Pahlana P, Vogt M, Wood R. Diagnostic yield of tuberculosis using sputum induction in HIV-positive patients before antiretroviral therapy. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2012;16(10):1354–7.
- Chew MY, Ng J, Cai H-M, Lim TG, Lim TK. The clinical utility of Xpert® MTB/RIF testing in induced sputum. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2016;20(12):1668–70.
- Jiang Q, Ji L, Qiu Y, Su X, Guo M, Zhong S, et al. A randomised controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2019;23(6):685–91.
- Gopathi NR, Mandava V, Namballa UR, Makala S. A Comparative Study of Induced Sputum and Bronchial Washings in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis. J Clin Diagn Res JCDR. 2016;10(3):OC07-10.
- Prakash P, Agarwal P, Gupta A, Gupta E, Dasgupta A. Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis. Indian J Chest Dis Allied Sci. 2016;58(3):173–5.
- Luhadia A, Kapur M, Luhadia S, Sharma R, Chhabra G, Sharma S. Comparison of Induced Sputum and Fibre-Optic Bronchoscopy (Fob) in the Early Diagnosis of Sputum Smear Negative Suspected Cases of Pulmonary Tuberculosis under Rntcp Settings-A Study Conducted in Southern Part of Rajasthan. J Pulm Respir Med. 2017;07(3):410.
- Luo W, Lin Y, Li Z, Wang W, Shi Y. Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis. BMC Pulm Med. 2020;20(1):146.
- Ugarte-Gil C, Elkington PT, Gotuzzo E, Friedland JS, Moore DAJ. Induced sputum is safe and well-tolerated for TB diagnosis in a resource-poor primary healthcare setting. Am J Trop Med Hyg. 2015;92(3):633–5.
- Biswas S, Das A, Sinha A, Das SK, Bairagya TD. The role of induced sputum in the diagnosis of pulmonary tuberculosis. Lung India Off Organ Indian Chest Soc. 2013;30(3):199–202.
- Geldenhuys HD, Whitelaw A, Tameris MD, Van As D, Luabeya KKA, Mahomed H, et al. A controlled trial of sputum induction and routine collection methods for TB diagnosis in a South African community. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2014;33(12):2259–66.
- Rueda ZV, López L, Marín D, Vélez LA, Arbeláez MP. Sputum induction is a safe procedure to use inprisoners and MGIT is the best culture method to diagnose tuberculosis inprisons: a cohort study. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2015;33:82–8.
References
Organisation Mondiale de la Santé. Tuberculose [Internet]. [cited 2021 Mar 25]. Available from: https://www.who.int/fr/news-room/fact-sheets/detail/tuberculosis
Shete PB, Farr K, Strnad L, Gray CM, Cattamanchi A. Diagnostic accuracy of TB-LAMP for pulmonary tuberculosis: a systematic review and meta-analysis. BMC Infect Dis. 2019;19(1):268.
Bitchong Ekono CF, Mballa Amougou JC, Azoumbou Mefant T, Massongo Massongo, Issalne Palai Y, ZE JJ, et al. Profil Épidémio-Clinique, Paraclinique et Évolutif des Patients Traités pour Tuberculose à l’Hôpital Jamot de Yaoundé. Health Sci Dis [Internet]. 2018;19(4). Available from: www.hsd-fmsb.org
Programme National de Lutte contre la Tuberculose. Guide technique pour les personnels de santé au Cameroun. 2019.
Agbor AA, Bigna JJR, Billong SC, Tejiokem MC, Ekali GL, Plottel CS, et al. Factors associated with death during tuberculosis treatment of patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon: an 8-year hospital-based retrospective cohort study (2006-2013). PloS One. 2014;9(12):e115211.
Yone EWP, Kengne AP, Kuaban C. Incidence, time and determinants of tuberculosis treatment default in Yaounde, Cameroon: a retrospective hospital register-based cohort study. BMJ Open. 2011;1(2):e000289.
Balkissou AD, Poka-Mayap V, Massongo M, Pefura-Yone EW. Incidence et facteurs prédictifs de décès au cours de la tuberculose dans deux régions camerounaises. Rev Mal Respir Actual. 2021;13(1):230.
Balkissou AD, Poka-Mayap V, Massongo M, Pefura-Yone EW. Facteurs prédictifs des perdus de vue au cours de la tuberculose dans deux régions camerounaises. Rev Mal Respir Actual. 2021;13(1):229–30.
Park JS. Efficacy of Induced Sputum for the Diagnosis of Pulmonary Tuberculosis in Adults Unable to Expectorate Sputum. Tuberc Respir Dis. 2015;78(3):203–9.
Lawn SD, Kerkhoff AD, Pahlana P, Vogt M, Wood R. Diagnostic yield of tuberculosis using sputum induction in HIV-positive patients before antiretroviral therapy. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2012;16(10):1354–7.
Chew MY, Ng J, Cai H-M, Lim TG, Lim TK. The clinical utility of Xpert® MTB/RIF testing in induced sputum. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2016;20(12):1668–70.
Jiang Q, Ji L, Qiu Y, Su X, Guo M, Zhong S, et al. A randomised controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2019;23(6):685–91.
Gopathi NR, Mandava V, Namballa UR, Makala S. A Comparative Study of Induced Sputum and Bronchial Washings in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis. J Clin Diagn Res JCDR. 2016;10(3):OC07-10.
Prakash P, Agarwal P, Gupta A, Gupta E, Dasgupta A. Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis. Indian J Chest Dis Allied Sci. 2016;58(3):173–5.
Luhadia A, Kapur M, Luhadia S, Sharma R, Chhabra G, Sharma S. Comparison of Induced Sputum and Fibre-Optic Bronchoscopy (Fob) in the Early Diagnosis of Sputum Smear Negative Suspected Cases of Pulmonary Tuberculosis under Rntcp Settings-A Study Conducted in Southern Part of Rajasthan. J Pulm Respir Med. 2017;07(3):410.
Luo W, Lin Y, Li Z, Wang W, Shi Y. Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis. BMC Pulm Med. 2020;20(1):146.
Ugarte-Gil C, Elkington PT, Gotuzzo E, Friedland JS, Moore DAJ. Induced sputum is safe and well-tolerated for TB diagnosis in a resource-poor primary healthcare setting. Am J Trop Med Hyg. 2015;92(3):633–5.
Biswas S, Das A, Sinha A, Das SK, Bairagya TD. The role of induced sputum in the diagnosis of pulmonary tuberculosis. Lung India Off Organ Indian Chest Soc. 2013;30(3):199–202.
Geldenhuys HD, Whitelaw A, Tameris MD, Van As D, Luabeya KKA, Mahomed H, et al. A controlled trial of sputum induction and routine collection methods for TB diagnosis in a South African community. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2014;33(12):2259–66.
Rueda ZV, López L, Marín D, Vélez LA, Arbeláez MP. Sputum induction is a safe procedure to use inprisoners and MGIT is the best culture method to diagnose tuberculosis inprisons: a cohort study. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2015;33:82–8.