open access

Vol 87, No 5 (2019)
ORIGINAL PAPERS
Published online: 2019-10-31
Submitted: 2019-05-07
Accepted: 2019-10-19
Get Citation

Sputum culture for the diagnosis of tuberculous pleural effusion: analysis of absolute and incremental yields

Sevak Keshishyan, Viren Kaul, Anupam Gupta, Chul Ahn, Wilbert S. Aronow, Oleg Epelbaum
DOI: 10.5603/ARM.2019.0050
·
Pubmed: 31680228
·
Adv Respir Med 2019;87(5):281-288.

open access

Vol 87, No 5 (2019)
ORIGINAL PAPERS
Published online: 2019-10-31
Submitted: 2019-05-07
Accepted: 2019-10-19

Abstract

Introduction: Pleural fluid culture yield in tuberculous pleural effusion (TPE) is disappointing in immunocompetent hosts. Herein, we attempt to define the role of serial sputum cultures in the diagnosis of TPE.
Material and methods: We identified cases diagnosed with TPE over a 16-year period in a high-prevalence US hospital. Absolute yields of one, two, and three sputa were calculated as well as the incremental yield of adding second and third sputa. These calculations were then performed separately for expectorated and induced sputum and for patients with and without infiltrates on chest X-ray.
Results: Sixty sputum collections were performed in 46 patients with TPE. The per-patient sensitivity of sputum culture was 45.6%. On a per-sputum collection basis, the overall yield of the first sputum was 30%, of two sputa 39%, and of three sputa 54%. The corresponding incremental yields were 9% and 15%, respectively. The three-sputum yields of expectorated and induced collections were similar. The three-sputum yield in patients with infiltrates on X-ray was 11% lower than that in those without infiltrates.
Conclusions: Serial sputum collection of three specimens can be expected to produce a yield of > 50% in cases of suspected TPE regardless of whether obtained by expectoration or induction, and the yield increases incrementally.

Abstract

Introduction: Pleural fluid culture yield in tuberculous pleural effusion (TPE) is disappointing in immunocompetent hosts. Herein, we attempt to define the role of serial sputum cultures in the diagnosis of TPE.
Material and methods: We identified cases diagnosed with TPE over a 16-year period in a high-prevalence US hospital. Absolute yields of one, two, and three sputa were calculated as well as the incremental yield of adding second and third sputa. These calculations were then performed separately for expectorated and induced sputum and for patients with and without infiltrates on chest X-ray.
Results: Sixty sputum collections were performed in 46 patients with TPE. The per-patient sensitivity of sputum culture was 45.6%. On a per-sputum collection basis, the overall yield of the first sputum was 30%, of two sputa 39%, and of three sputa 54%. The corresponding incremental yields were 9% and 15%, respectively. The three-sputum yields of expectorated and induced collections were similar. The three-sputum yield in patients with infiltrates on X-ray was 11% lower than that in those without infiltrates.
Conclusions: Serial sputum collection of three specimens can be expected to produce a yield of > 50% in cases of suspected TPE regardless of whether obtained by expectoration or induction, and the yield increases incrementally.

Get Citation

Keywords

tuberculosis, mycobacteria, pleural effusion, infection

About this article
Title

Sputum culture for the diagnosis of tuberculous pleural effusion: analysis of absolute and incremental yields

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 5 (2019)

Pages

281-288

Published online

2019-10-31

DOI

10.5603/ARM.2019.0050

Pubmed

31680228

Bibliographic record

Adv Respir Med 2019;87(5):281-288.

Keywords

tuberculosis
mycobacteria
pleural effusion
infection

Authors

Sevak Keshishyan
Viren Kaul
Anupam Gupta
Chul Ahn
Wilbert S. Aronow
Oleg Epelbaum

References (12)
  1. World Health Organization. Global Tuberculosis Report 2014. Available at: www.who.int/tb/publications/global_report/en/ [access: 22.10.2019].
  2. New York State Department of Health. Data & Reports 2014. Available at: http://www.health.ny.gov/statistics/chac/general/pdf/g36.pdf [access: 30.12.2015].
  3. Gopi A, Madhavan SM, Sharma SK, et al. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007; 131(3): 880–889.
  4. Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017; 64(2): 111–115.
  5. Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003; 167(5): 723–725.
  6. Weiszhar Z, Hovarth I. Implementing p-M Analysis Step-by- Step. Breath. 2013; 9: 300–306.
  7. Rieder HL, Chiang CY, Rusen ID. A method to determine the utility of the third diagnostic and the second follow-up sputum smear examinations to diagnose tuberculosis cases and failures. Int J Tuberc Lung Dis. 2005; 9(4): 384–391.
  8. Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973; 63(1): 88–92.
  9. Kim HJ, Lee HJu, Kwon SY, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. 2006; 129(5): 1253–1258.
  10. Seibert A, Haynes J, Middleton R, et al. Tuberculous pleural effusion. Chest. 1991; 99(4): 883–886.
  11. Valdés L, Alvarez D, San José E, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998; 158(18): 2017–2021.
  12. Ruan SY, Chuang YC, Wang JY, et al. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax. 2012; 67(9): 822–827.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl