Study of respiratory symptoms among sputum positive
Study of respiratory symptoms among sputum positive Study of respiratory symptoms among sputum positive
!fffwwoj"£iterature smaller volumes. Quality and quantity of sputum specimens were assessed independently. The likelihood of a positive smear is increased three-folds, and that of a culture two folds when sputum quality is good, irrespective of sputum quantity. In specimens of sufficient quantity, both smear and culture positivity are doubled when compared to specimens with a volume of less than 3m!. More than 80 % of positive smears and cultures are originated from specimens of good quality and of sufficient quantity. Macroscopical evaluation of sputum specimens contributes to optimizing laboratory diagnosis, and may have a financial impact on the cost involved in the diagnosis ofpulmonary TB (Weyer, 1990 and kramer et aI., 1990). 2) Sputum induction: There are several methods for obtaining sputum from the cooperative patients with non productive cough. One ofthese methods is the inhalation of warm, aerosolized hypertonic (5 % -10 % ) saline which irritates the lungs enough to induce both coughing and the production ofa thin, watery specimen. After induction, patient may cough and produce additional good quality specimens, which should also be submitted to the laboratory (ATS, 1990). It has been concluded that in addition to obtaining sputum from patients who are unable to expectorate, sputum induction may have a useful role in improving the care detection rate ofsmear positive pulmonary TB, particularly in areas where facilities for more invasive and expensive techniques such as fibreoptic bronchoscopy are not available (Parry et aI., 1995). 3) Bronchoscopic specimens: When neubulization is ineffective or an immediate diagnosis is needed bronchoscopy is the next best choice because this procedure 51
provides additional material for study (Washings, bmshings, and biopsy specimens) and can help one obtain rapid diagnosis of tuberculosis (Zheng and Roberts, 1999). Wallace et al. (1981), found that in 41 patients proved to have TB, cultures of specimens, taken during fiberoptic bronchoscopy, were positive in 39 cases. The post-bronchoscopy sputum was the most helpfull specimen in the diagnosis of pulmonary tuberculosis in patients with repeated negative sputum by direct smear and in whom sputum could not be produced (Abd-El-Hakim et al., 1987). Also Osman et al,, (1995), concluded that fiberoptic bronchoscopy is a valuable diagnostic tool for pulmonary mycobacterial infection. The local anesthetics used during fiberoptic bronchoscopy may be lethal to M. tuberculosis, so specimens for culture should be obtained with a minimal amount of anesthesia. However irritation of bronchial tree during the fiberoptc bronchoscopy procedure will frequently leave the patient with productive cough. This post-bronchoscopy sputum was the only source of positive inaterial in some study (Rossman and Oner- Eyuboglu, 1998). 4) Gastric lavage : Gastric lavage may be necessary for children and some adult patients who are unable to expectorate sputum, gastric lavage is a specimen of alternative choice, although it my not be as good as induced sputum for culturing (Pomputius et al., 1997). Some of gastric contents should be aspirated early in the morning, after the patient has fasted at least 8-10 hours, and preferably while the patient is still in bed (ATS, 1990).
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provides additional material for study (Washings, bmshings, and biopsy<br />
specimens) and can help one obtain rapid diagnosis <strong>of</strong> tuberculosis (Zheng<br />
and Roberts, 1999).<br />
Wallace et al. (1981), found that in 41 patients proved to have TB,<br />
cultures <strong>of</strong> specimens, taken during fiberoptic bronchoscopy, were <strong>positive</strong><br />
in 39 cases. The post-bronchoscopy <strong>sputum</strong> was the most helpfull specimen<br />
in the diagnosis <strong>of</strong> pulmonary tuberculosis in patients with repeated<br />
negative <strong>sputum</strong> by direct smear and in whom <strong>sputum</strong> could not be<br />
produced (Abd-El-Hakim et al., 1987). Also Osman et al,, (1995),<br />
concluded that fiberoptic bronchoscopy is a valuable diagnostic tool for<br />
pulmonary mycobacterial infection.<br />
The local anesthetics used during fiberoptic bronchoscopy may be<br />
lethal to M. tuberculosis, so specimens for culture should be obtained with<br />
a minimal amount <strong>of</strong> anesthesia. However irritation <strong>of</strong> bronchial tree during<br />
the fiberoptc bronchoscopy procedure will frequently leave the patient with<br />
productive cough. This post-bronchoscopy <strong>sputum</strong> was the only source <strong>of</strong><br />
<strong>positive</strong> inaterial in some study (Rossman and Oner- Eyuboglu, 1998).<br />
4) Gastric lavage :<br />
Gastric lavage may be necessary for children and some adult patients<br />
who are unable to expectorate <strong>sputum</strong>, gastric lavage is a specimen <strong>of</strong><br />
alternative choice, although it my not be as good as induced <strong>sputum</strong> for<br />
culturing (Pomputius et al., 1997). Some <strong>of</strong> gastric contents should be<br />
aspirated early in the morning, after the patient has fasted at least 8-10<br />
hours, and preferably while the patient is still in bed (ATS, 1990).
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