Safety and tolerability of sputum induction in adolescents and adults with suspected pulmonary tuberculosis.

Sputum induction by the inhalation of hypertonic saline may increase the yield of microbiological diagnosis of pulmonary tuberculosis (TB). This is particularly relevant in paucibacillary TB, such as in children or human immunodeficiency virus (HIV)-infected patients. Sputum induction must be shown to be safe and tolerable in community settings where invasive diagnostic methods are unavailable. The objective of this study was to describe the changes in physiological parameters and adverse events occurring during sputum induction in ambulatory adult and adolescent TB suspects recruited in community clinics. Sputum induction was performed in HIV-infected (n = 35) and HIV-uninfected (n = 67) TB suspects (n = 102). Oxygen saturation (%), blood pressure (mm Hg), heart rate (/minute), respiratory rate (/minute), and adverse events were monitored at baseline, continuously during the salbutamol pre-treatment and saline nebulization phases, and for 30 min afterwards. During nebulization, there was a statistically significant increase in oxygen saturation (1%, p < 0.0001), systolic BP (7 mm Hg, p < 0.0001), and diastolic BP (2 mm Hg, p = 0.008). Post-nebulization decrease in the systolic BP occurred (4 mm Hg, p = 0.016). These changes were not considered to be clinically significant. Eight minor, transitory, self-resolving adverse events occurred (labored breathing, n = 2; chest pain, n = 2; paroxysmal coughing, n = 1; elevated heart rate, n = 1; vomiting, n = 1; hypotension, n = 1), leading to procedure termination in four participants. No serious adverse events occurred. Induced sputum is safe, tolerable, and feasible in adult and adolescent TB suspects in a community healthcare setting.

The tuberculin skin test: a comparison of ruler and calliper readings.

BACKGROUND: The Mantoux tuberculin skin test (TST) is widely used to diagnose latent infection with Mycobacterium tuberculosis. TST skin induration may be measured either by a transparent ruler or by a pair of callipers. We hypothesised that the type of instrument used may affect the reading. OBJECTIVE: To determine whether variability in Mantoux TST measurement is affected by the type of reading instrument. METHOD: A TST (Mantoux method) was performed among healthy adolescents. The indurations were read with among ruler and calliper by two independent readers. Limits of agreement and Kappa (κ) scores at TST positivity cut-off points were calculated. A Bland-Altman graph was constructed. RESULTS: The 95% limits of agreement between instruments ranged from -5 mm to 3 mm. The limits of agreement between readers ranged from -5 mm to 4 mm. κ scores between instruments were respectively 0.7 and 0.8 at 15 mm and 10 mm cut-offs. CONCLUSION: The variability between readers of TST indurations is not influenced by changing the reading instrument.