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A controlled trial of sputum induction and routine collection methods for TB diagnosis in a South African community

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Abstract

The diagnostic yield of pulmonary tuberculosis (TB) by sputum induction (SI) at the first point of contact with health services, conducted in all patients with suspected TB regardless of the ability to expectorate spontaneously, has not been evaluated. We compared the 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. The 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. A total of 555 subjects completed the SI procedure, of whom 132 (24 %) were human immunodeficiency virus (HIV)-infected. One hundred and twenty-nine samples (129, 23 %) were M. tuberculosis culture-positive. The time-to-positivity of Mycobacteria Growth Indicator Tube (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 the culture-positive diagnostic yield between SI and spot expectorated sputum [difference +0.7 %; confidence interval (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 the 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.

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Acknowledgments

The authors wish to thank the following for the collection of data: 1,2Manshil Misra, 1,2William Kleynhans, 1,2Norma Buckerfield, 1,2Susan Rossouw, 1,2Elizabeth Filander, and the 1,2SATVI Induced Sputum team.

1South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), and 2School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.

Contributions of authors

HDG and MH contributed towards the study planning, study conduct, and drafted the early versions of the manuscript. All other authors were involved in planning the study, implementation, and commenting on the draft manuscript. All authors approved the final version.

The study was approved by the University of Cape Town Human Research Ethics Committee (Human Subjects Assurance number 00001637) and written informed consent was obtained for participation. The study was conducted in accordance with the Declaration of Helsinki.

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

This work was supported by a grant from the National Institutes of Health (NIH), USA (grant number R01 AI75603-02).

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Authors and Affiliations

  1. South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa

    H. D. Geldenhuys, M. D. Tameris, D. Van As, K. K. A. Luabeya, H. Mahomed, G. Hussey, W. A. Hanekom & M. Hatherill

  2. School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

    H. D. Geldenhuys, M. D. Tameris, D. Van As, K. K. A. Luabeya, H. Mahomed, G. Hussey, W. A. Hanekom & M. Hatherill

  3. Division of Medical Microbiology, Faculty of Health Sciences, South Africa National Health Laboratory Service, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa

    A. Whitelaw

Authors
  1. H. D. Geldenhuys
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  2. A. Whitelaw
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  3. M. D. Tameris
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  4. D. Van As
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  5. K. K. A. Luabeya
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  6. H. Mahomed
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  7. G. Hussey
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  8. W. A. Hanekom
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  9. M. Hatherill
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Corresponding authors

Correspondence to H. D. Geldenhuys or M. Hatherill.

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Geldenhuys, H.D., Whitelaw, A., Tameris, M.D. 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 33, 2259–2266 (2014). https://doi.org/10.1007/s10096-014-2198-4

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  • DOI: https://doi.org/10.1007/s10096-014-2198-4

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