Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis

  • Y. Gonzalez-Angulo
  • C. S. Wiysonge
  • H. Geldenhuys
  • W. Hanekom
  • H. Mahomed
  • G. Hussey
  • M. HatherillEmail author


Sputum induction (SI) has been proposed as the optimal sample collection method for patients with paucibacillary tuberculosis (TB). Studies reporting the culture of Mycobacterium tuberculosis from SI were reviewed. A random-effects meta-analysis of diagnostic yield (numerator M. tuberculosis SI culture-positive cases; denominator all culture-positive cases) was conducted. Diagnostic yields (95% confidence intervals, CIs) were displayed as Forest plots. Heterogeneity was evaluated using Chi-squared and I-squared tests and meta-regression analysis. Ninety publications were screened, 28 full-text papers reviewed, and 17 analyzed. Collectively, n = 627 SI culture-positive cases among n = 975 culture-confirmed TB cases were reported. The diagnostic yield of SI ranged from 35 to 95%. The pooled diagnostic yield was 74% (CI 65–81%), with significant heterogeneity (p < 0.0001, I2 = 86%). There were no statistically significant differences in the yield between sub-groups defined by human immunodeficiency virus (HIV) prevalence or age. Univariate analysis demonstrated that the use of fiberoptic bronchoscopy (FOB) as the comparator method was associated with a 22% reduction (CI 2–42%) in the diagnostic yield of SI. However, after adjustment for confounding, the meta-regression analysis showed that FOB usage (p = 0.21) and saline concentration (p = 0.31) were not independently associated with the diagnostic yield. SI will detect approximately three-quarters of M. tuberculosis culture-positive cases under study conditions. Significant heterogeneity in the diagnostic yield was not explained by HIV prevalence, age, or the use of FOB as the comparator method. The use of a particular nebulized saline concentration for SI cannot be recommended on the basis of this meta-regression analysis.


Human Immunodeficiency Virus Diagnostic Yield Human Immunodeficiency Virus Prevalence Gastric Lavage Fiberoptic Bronchoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Financial support

Y.G.-A. is the recipient of a SATVI Masters Scholarship and M.H. and W.H. are supported by a National Institutes of Health (NIH) grant (1R01AI075603-01).

Potential conflicts of interest

All authors: no conflicts.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Y. Gonzalez-Angulo
    • 1
    • 2
    • 3
  • C. S. Wiysonge
    • 2
    • 3
  • H. Geldenhuys
    • 1
    • 2
    • 3
  • W. Hanekom
    • 1
    • 2
    • 3
  • H. Mahomed
    • 1
    • 2
    • 3
  • G. Hussey
    • 1
    • 2
    • 3
  • M. Hatherill
    • 1
    • 2
    • 3
    Email author
  1. 1.South African Tuberculosis Vaccine Initiative (SATVI), Wernher Beit Building N2.10, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
  2. 2.Institute of Infectious Disease & Molecular MedicineUniversity of Cape TownCape TownSouth Africa
  3. 3.School of Child & Adolescent HealthUniversity of Cape TownCape TownSouth Africa

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