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

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Abstract

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.

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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).

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All authors: no conflicts.

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Authors and Affiliations

  1. South African Tuberculosis Vaccine Initiative (SATVI), Wernher Beit Building N2.10, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa

    Y. Gonzalez-Angulo, H. Geldenhuys, W. Hanekom, H. Mahomed, G. Hussey & M. Hatherill

  2. Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa

    Y. Gonzalez-Angulo, C. S. Wiysonge, H. Geldenhuys, W. Hanekom, H. Mahomed, G. Hussey & M. Hatherill

  3. School of Child & Adolescent Health, University of Cape Town, Cape Town, South Africa

    Y. Gonzalez-Angulo, C. S. Wiysonge, H. Geldenhuys, W. Hanekom, H. Mahomed, G. Hussey & M. Hatherill

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  1. Y. Gonzalez-Angulo
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  2. C. S. Wiysonge
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  3. H. Geldenhuys
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  4. W. Hanekom
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  5. H. Mahomed
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  6. G. Hussey
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  7. M. Hatherill
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Correspondence to M. Hatherill.

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Author contributions

Y. Gonzalez-Angulo contributed to the design of the study, data collection, data analysis, and wrote the final manuscript; C.S. Wiysonge contributed to the design of the study, data analysis, and writing the manuscript; H. Geldenhuys contributed to writing the manuscript; W. Hanekom contributed to writing and editing the manuscript; H. Mahomed contributed to writing and editing the manuscript; G. Hussey contributed to writing and editing the manuscript; M. Hatherill contributed to the design of the study, data analysis, and writing of the final manuscript.

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Gonzalez-Angulo, Y., Wiysonge, C.S., Geldenhuys, H. et al. Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 31, 1619–1630 (2012). https://doi.org/10.1007/s10096-011-1485-6

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  • DOI: https://doi.org/10.1007/s10096-011-1485-6

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