Am. J. Respir. Crit. Care Med., Volume 162, Number 6, December 2000, 2238-2240

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

MARCUS B. CONDE, SERGIO L. M. SOARES, FERNANDA C. Q. MELLO, VALERIA M. REZENDE, LUCIANA L. ALMEIDA, ARTHUR L. REINGOLD, CHARLES L. DALEY, and AFRANIO L. KRITSKI

Unidade de Pesquisa em Tuberculose, Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; School of Public Health, University of California, Berkeley; and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California

Many patients with suspected pulmonary tuberculosis (PTB) do not produce sputum spontaneously or are smear-negative for acid-fast bacilli (AFB). We prospectively compared the yield of sputum induction (SI) and fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) for the diagnosis of PTB in a region with a high prevalence of tuberculosis and human immunodeficiency virus (HIV) infection. Fifty seven percent (143 of 251) of patients had diagnoses of PTB, of whom 17% (25 of 143) were HIV seropositive. There were no significant differences in the yields of AFB smears or cultures whether obtained via SI or BAL. Among 207 HIV-seronegative patients, the AFB smear and mycobacterial culture results from specimens obtained by SI and BAL were in agreement in 97% (202 of 207) (kappa test = 0.92) and 90% (186 of 207) (kappa test = 0.78), respectively. Among HIV-seropositive patients the agreements between AFB smear and culture results for SI and BAL specimens were 98% (43 of 44) (kappa test = 0.93) and 86% (38 of 44) (kappa test = 0.69), respectively. We conclude that SI is a safe procedure with a high diagnostic yield and high agreement with the results of fiberoptic bronchoscopy for the diagnosis of PTB in both HIV-seronegative and HIV-seropositive patients.

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