Diagnostic yield of sputum microbiological analysis in the diagnosis of pulmonary tuberculosis in a period of 10 years.

INTRODUCTION: Pulmonary tuberculosis (TB) requires an early diagnosis for prompt introduction of treatment and prevention of transmission. Definitive diagnosis is obtained by microbiological culture and identification of Mycobacterium tuberculosis in respiratory specimens, mostly sputum samples. MATERIALS AND METHODS: Retrospective data analysis of all patients suspected of pulmonary TB that submitted three consecutive sputum samples to the Pulmonology Diagnostic Center (PDC) Laboratory between 2004 and 2013. Extrapulmonary TB cases were excluded. Four microbiological analyses were executed on each specimen: two smears with Ziehl-Neelsen staining, direct and concentrate; and two culture examinations, one in liquid and one in solid medium. Statistical analysis was performed by SPSS. RESULTS: A total of 694 patients were enrolled in this study (65% men, mean age 48.5±18.6 years, 97% Portuguese), most of them exhibiting TB-related complaints. Pulmonary TB was diagnosed in 41% of the patients; 54% had non-specific radiological changes and 34% had pulmonary cavitation. The cumulative sensitivity rates of each of the three smears were 24.6%, 27.7% and 28.8% for concentrated samples and 19.3%, 20.4% and 22.5% for direct samples. The cumulative sensitivities of sputum culture were 33.3%, 37.9% and 41.8% for solid medium, and 43.9%, 51.6% and 55.4% for liquid medium. Pondering all forms of microbiological analysis, the cumulative sensitivities of each sample were 51.2%, 59.6% and 63.2%. There was an incremental yield of 8.4% for the second specimen and 3.5% for the third specimen. All sensitivity rates were higher among patients with pulmonary cavitation. CONCLUSIONS: This study showed an incremental yield with more than one sputum sample. However, overall sensitivity remained low, suggesting a need for new diagnostic strategies and novel and better diagnostic tools.

Lung function in hyper IgE syndrome.

Pneumatoceles and bronchiectasis are secondary complications of respiratory infections in patients with hyper IgE syndrome (HIgES). We report on a patient with HIgES and recurrent pneumonias since 1 year of age, with progression to pneumatoceles and bronchiectasis and fatal outcome, with disseminated infection and suspected allergic bronchopulmonary aspergillosis, who was subjected to sequential spirometric assessment. We describe the early beginning of respiratory infections, difficulties in the management of pulmonary sequelae and the impact of an early functional diagnosis and follow-up of the patient regarding a disease for which lung function has not been fully described.

Allergic and immunologic parameters in patients with Fanconi's anemia.

BACKGROUND: Fanconi's anemia (FA) is a rare recessive chromosomal instability disorder, characterized by progressive bone marrow failure and congenital defects. Patients with FA present with recurrent infections, particularly those of the respiratory tract. OBJECTIVE: The aim of the present study was to evaluate whether patients with FA have altered antibody-mediated immune responses. METHODS: A group of 12 patients with FA, 5-32 years old (6 males) was studied. Serum levels of IgG, IgM, IgA and IgG subclasses, isohemagglutinin titers and specific IgG antibodies to poliovirus and measles were determined using standard methods. Immediate skin tests to common inhalant allergens were performed, and total and specific serum IgE was quantitated using a fluoroenzymatic assay (Uni-CAP, Pharmacia). Antipneumococcal antibodies were measured by ELISA before and 4-8 weeks after immunization with pneumococcal vaccine (Pneumo 23, Pasteur Mérieux Connaught). Responses to serotypes 1, 3, 5, 6B, 9V and 14, which are the most prevalent in our country, were studied. RESULTS: Ten patients had elevated IgE levels in sera, and 7 of them had detectable specific IgE and positive immediate skin tests. An inadequate response to pneumococcal vaccination was found in 2 of the 12 patients. Isohemagglutinin titers and levels of IgG, IgM, IgA and IgG subclasses and antipoliovirus and antimeasles antibodies were within the normal limits for age in all patients. Two patients had undetectable IgG4 levels (below 5 mg/dl). CONCLUSIONS: The results indicate that a proportion of patients with FA (2/12) in our study had inadequate responses to pneumococcal vaccination. No other significant abnormalities of the immune system were found in these patients.