Published ahead of print on October 19, 2006, doi:10.1164/rccm.200608-1092OC Am. J. Respir. Crit. Care Med., Volume 175, Number 1, January 2007, 80-86 A more recent version of this article appeared on January 1, 2007
Submitted on August 4, 2006 Diagnostic Yield of Sputum, Induced Sputum and Bronchoscopy after Radiological TB ScreeningOtto D Schoch1*,1 Kantonsspital, St. Gallen, Switzerland, 2 Hospital Saint Loup, Pompaples, Switzerland, 3 University Hospital, Basel, Switzerland, 4 Swiss Federal Office of Public Health, Berne, Switzerland, 5 Swiss Lung Association, Berne, Switzerland, 6 Tuberculosis Consultant Services, Kirchlindach, Switzerland, 7 Kantonsspital, Munsterlingen, Switzerland * To whom correspondence should be addressed. E-mail: otto.schoch{at}kssg.ch.
Rationale: To assess feasibility and yield of diagnostic procedures after active case finding for tuberculosis with radiological screening at the three main entry points for asylum seekers to Switzerland. Method: Prospective multi-center study on the value of symptoms, spontaneous and induced sputum, and bronchoscopy for the confirmation of tuberculosis in radiological suspect cases. Results: Among 101 asylum seekers examined, spontaneous sputum was collected on-the-spot in 83 and yielded 7(54%) of 13 smear- and 13(39%) of 33 culture-positive cases. Morning sputum, collected in 84, yielded 8(62%) and 16(49%), and the two combined 9(69%) and 20(61%), respectively. Two additional induced sputa, collected in 91, yielded no additional smear-, but 7 culture-positive cases (yield 82%). Bronchoscopy, performed in 87 of 92 sputum-smear negative cases, yielded 4 additional smear- and 6 culture-positive cases. Culture confirmation was independently and significantly predicted by obtaining a specimen from bronchoscopy (adjusted odds ratio (AOR) 11.0, 95% confidence interval [CI] 1.9-62) and a prior decision to treat (AOR 3.0, CI 1.1-8.1). Conclusion: Radiographic anomalies compatible with tuberculosis found during screening are a poor guide to initiation of treatment. Respiratory and systemic symptoms correlated weakly with culture confirmation of tuberculosis. All radiological suspect cases must be examined with on-the-spot and early-morning sputum, irrespective of symptoms. If both specimens are smear-negative, the yield is increased by bronchoscopy and, to a lesser extent, by 2 samples of induced sputum. The examination of any single specimen has a low yield of 36% to 63% and is insufficient to exclude active tuberculosis. Key words: Tuberculosis, pulmonary; Immigrants; Mass Chest X-Ray
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