Littérature scientifique sur le sujet « Sputum samples – Examination »

Diagnosis Tuberculosis (TB) can establish by microscopic examination of acid-resistant bacilli in the patient's sputum. Sputum quality greatly affects the diagnosis of TB, but the sputum collected by patients at community health centers sometimes does not meet the sputum quality requirements. The objective of this study was to assess the quality of sputum anytime and outset sputum on acid-resistant bacilli examination, from volume, color and viscosity parameters. The type of research used is descriptive observational. Respondents were suspected TB patients at the Marabahan and Aluh-aluh Public Health Centers of South Kalimantan province, Indonesia. Sputum samples taken were sputum anytime the first and outset sputum. The variables in this study are volume, color, and viscosity of sputum. The coloring of acid-resistant bacilli method Ziehl Nielsen. The results of the acid-resistant bacilli examination on sputum (86 specimens) found positive one (13%), positive three (2%), negative (85%). In morning sputum (86 specimens) found positive one (14%), positive three (2%), negative (84%). Sputum quality when with the good category as much as 36% and the quality of morning sputum with the good category as much as 55%. Conclusion Sputum outset has better quality than sputum at the anytime.

The background of the study is whether there are differences in the results of microscopic smear reading andthe quality of direct sputum preparations, check with sputum 24 hours at room temperature. The purpose ofthe study was to determine the effect of delaying the handling of sputum on the results of microscopicreadings of preparations in tuberculosis patients. Type of descriptive observation research. Research timeJune 2019. Research location at the Regional Health Laboratory of North Sumatra Province. The resultsshowed that from 16 sputum samples that were immediately examined, the scanty results were 2 samples, 1+there were 2 samples, 2+ there were 2 samples, 3+ there were 10 samples, whereas in the 24 hour sample atroom temperature, there were 2 negative results, 1+ there are 4, 2+ there are 3, and 3+ there are 7 samplesof BTA. Of the 16 sputum, they were immediately examined by delaying 24 hours at room temperature, 7sputum were obtained, the results of which were reduced. There is no positive number added, the samenumber of positive results is 9 sputum. This suggests that a 24-hour delay in sputum examination at roomtemperature can result in false positives. There are differences in the results between sputum directlychecked by being delayed 24 hours at room temperature 25⁰C. It is recommended that an AFB sputum beexamined immediately to avoid the results of false negative smear microscopic examination.

The microscopic examination of smear from sputum specimens plays an important role in the initial diagnosis and monitoring of pulmonary TB treatment. The Ziehl Nelseen method is the method for examining acid-resistant bacteria smear recommended by WHO. This method has high specificity for detecting acid-resistant bacteria in sputum. This study aims to determine the effect of postponement of sputum smear staining on the quality of acid-resistant bacteria germs on the results of microscopic examination using the Ziehl Nelseen staining method. The length of time to delay staining used was 3 days, 2 days and the control was direct preparations staining. The sample used was positive smear sputum. The results showed that from 10 samples of sputum, the results obtained were directly stained with results of 1+ there were 7 samples, and 2+ there were 3 samples, while the samples with the preparations were delayed for 2 days and 3 days at room temperature, respectively +1 as many as 7 samples, and 2+ as many as 3 samples. However, there was no difference in the reading of the staining results between the direct stained samples with the stained preparations with a delay of 2 days and 3 days at room temperature. The results of this study still have many shortcomings and to improve them it is recommended to carry out further research with a larger scale and sample size.

The microscopic examination of gram stained sputum sample aids in diagnosis of patients with lower respiratory tract infections. Gram stain plays the key role in deciding the appropriateness of the quality of the sputum sample received in the laboratory for culture. It helps to determine the represent ativeness of the sample for the site of collection intended. This study was done to correlate gram stain findings with culture and to assess the use of Gram stain in sputum examination in diagnostic microbiology. During 2017 (July to December) a total of 133 sputum samples were quality assessed using Bartlett’s grading system. The total scoring was done and sample showing score of 1 and above were cultured and identified based on colony characteristics, gram staining morphology and biochemical reactions. One hundred and thirty-three sputum samples were collected from patients with suspected lower respiratory tract infection. Of the 133 samples, 110(79%) were accepted and 23 (21%) were found to be unacceptable by Bartlett criteria. Potential pathogens were grown in 84 samples in the acceptable category. Normal respiratory flora were grown in 26 samples. Out of 84 samples, 63 samples were positive for bacterial growth and 21 showed fungal growth. Out of 63 bacterial growth, 44 were from in-patients and 19 were from out-patients. Among these bacterial isolates, 23 isolates were followed by 16 isolates were , 10 isolates were , 6 isolates were Staphylococcus aureus, 2 isolates were species, 3 isolates were and 3 isolates were Serratia marcesens. All the sputum samples should be subjected to gram staining before culture to differentiate true pathogens from contaminating flora on culture.

Objective: Rapid diagnosis of pulmonary tuberculosis (PTB) depends on microscopic examination of sputum smear for acid-fast bacilli (AFB). The direct microscopy examination lacks sensitivity. It needs at least 10,000 AFB/ml of sputum to observe in the smear. The objective of this study was to determine the efficacy of three different short-term bleach digestions and concentration of sputum in the diagnosis of PTB.Methods: A total of 171 sputum samples collected from patients suspected of having pulmonary TB were used. Direct smear was prepared using each sample and then divided into three parts to which equal volume of 5% bleach was added. The first part was kept at room temperature for 45 minutes with intermittent shaking. The second part was allowed to stand at room temperature for 45 minutes for sedimentation, and the third part was kept at room temperature for 45 minutes and then centrifuged at 3000 g for 15 minutes for deposit formation. Smears were prepared and stained with Ziehl-Neelsen method and observed for AFB using Revised National TB Control Programme Guidelines.Results: Out of 171 sputum samples, 45 (26.32%), 48 (28.07%), 49 (28.65%), and 55 (32.16%) of specimens were positive by direct, bleach digested mixed method, bleach digested sedimented method, and centrifugation method, respectively. The background of the bleach digested sputum smears was clear.Conclusion: Short-term bleach digestion of sputum improves the sensitivity of microscopic examination and the number of AFB observed in the smear. Bleach being a disinfectant kills AFB and makes handling of sputum safer.

Objectives: The objectives of the study were to find out the presence of Mycobacterium tuberculosis in sputum samples using Ziehl-Neelsen (ZN), Kinyoun’s, and (auramine) fluorescent staining and to compare the three staining techniques with and without Petroff’s concentration and to find out the most preferable staining of M. tuberculosis. Methods: Sputum sample was collected and concentrated by 4% NaOH (Petroff’s concentration). Microscopic examination of the sample was done before concentration and after concentration by ZN staining, Kinyoun’s staining, and fluorescent staining (Auramine). Grading of acid-fast bacilli (AFB) by three staining was done before and after concentration according to RNTCP guidelines.Results: Total of 452 sputum samples were collected and subjected to microscopy examination by ZN, Kinyoun’s, and fluorescent staining methods to compare the presence or absence of AFB with or without concentration. Among the 452 sputum samples, total of 67 (15.6%) sputum samples were positive for the presence of AFB. Majority 40.3% (n=21) of TB positive patients were observed in the age group 51–60 years. The results of Auramine-O staining showed positive diagnoses in 15.9% of the samples; sensitivity was 100% and specificity 95.6%.Conclusion: The use of fluorescent staining significantly increases the diagnostic value of the smear, particularly where there are low-density bacilli which may escape detection on ZN stained smears.

Introduction The aim of this study was to find out if bronchoalveolar lavage (BL) is better than gastric lavage (GL) or sputum (SP) examination for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis. Material and methods The study included a group of 30 children with suspected pulmonary tuberculosis, aged 6 months to 18 years. Gastric lavage was done on 4 consecutive mornings after overnight fast. Sputum was examined in 12 patients older than 10 years, (4 consecutive samples). BL was performed on the same day as the last GL and SP, using a rigid bronchoscope. Specimens were examined for the existence of BL acid fast bacilli (AFB) and culture for Mycobacterium tb. Results Out of 30 cases, Mycobacterium tb was grown in 13 BL samples (43.33%), and in 10 GL samples from the same patients (33.33%). Comparative analysis of microbiological samples of sputum and bronchoalveolar lavage fluid in 12 children showed that 6 patients had SP+ cultures and 6 patients had SP-cultures of Mycobacterium tb. All SP+ patients where also BL+, but 1 SP- patient was BL+. Smear examination of BL fluid samples was positive for AFB in 10 patients with positive cultures for Mycobacterium tb. Conclusion The results of our study indicate that BL examination is better than GL and SP examination for bacteriological diagnosis of childhood tuberculosis. .

Background: Under revised National tuberculosis control program two sputum samples are to be collected for diagnosis of presumptive pulmonary tuberculosis case. The objective of this study is to find the concordance of both sputum smear microscopy samples at a tertiary care hospital. Methods: Hospital based record was collected from designated microscopy center laboratory register. The data collected were from January 2015 to November 2016. Results: A total of 2117 paired of sputum sample were collected for the year 2015-16 in one of the DMC of a tertiary care hospital. A total of 183 patient (at least one sputum sample) were positive (8.64%) and 1934 were both negative. Among the positive sample concordance for both spot and morning samples were 89% (163/183) and discordance where spot sample positive and morning sample negative was 4.91% (9/183) and where spot sample negative and morning sample positive was 6.01% (11/183). Overall discordance between spot and morning samples were only 0.94% (20/2117). Conclusions: There is a good concordance of two sputum samples. Discordance of two sputum samples were <1% in a tertiary care hospital. One sample may be sufficient for operational purpose for diagnosis of pulmonary Tb. But to have a robust recommendation a RCT will be required to see the extent of discordance by ruling out bias in sputum smear examination.

In Indonesia, the diagnosis of pulmonary tuberculosis relies primarily on an identification of acid-fast bacilli on sputum smears. However, microscopic device has several limitations. The sensitivity of microscopic examination is variable. The quality of smear microscopic results is heavily depend on the workload, and the skill of the technician’s reading the slide. TB antigen rapid test device (TB Ag) is fast, easy and does not either need skillness of the operator. The kit detects specific secreted antigen M.tuberculosis coded by: RD (Region of Difference) 1, RD2 and RD3. These RD1−3 were found deleted from BCG (Bacille Calmette-Guerine) vaccine strain. In the present study, the diagnostic value of TB Ag was assessed. Sputum samples were examined from 59 suspected tuberculosis patients and 22 non tuberculosis patients. The samples of the suspected tuberculosis patients were collected as three consecutive sputum specimens (spot, morning, spot). The total 199 specimens were examined by sputum smear microscopy and TB Ag. M.tuberculosis culture by using Lowenstein Jensen media, which was used as a gold standard. The sensitivity and specificity of microscopic sputum smear were 83.8% (95% CI: 70.0–89.4) and 96.3% (95% CI: 89.8–98.7), respectively. While, the sensitivity and specificity of TB Ag were 72.6% (95% CI: 63.9–79.9) and 90.9% (95% CI: 72.2–97.5), respectively. The concordance between microscopic sputum smear and TB Ag was 70.8%. TB Ag can be considered as a new diagnostic tool for the diagnosis of pulmonary tuberculosis, especially at the health services where there is no expert technician available for microscopic sputum smear examination.

PCP is one of the most common opportunistic infection in HIV and AIDS patients. A definitive diagnosis of PCP in HIV and AIDS patients in Dr. Soetomo General Hospital Surabaya has not been previously done. A definitive diagnosis have the role in the therapy and to prevent the illness as well. PCP is diagnosed by using a microscope to indentify Pneumocystis jerovecii in the lung fluid or tisuue. The objective of this study was to know how to detect Pneumocystis jerovecii in the sputum samples and to know the determination of the prevalence of PCP in HIV and AIDS patients suffered with pulmonary symptom who were hospitalized in Dr. Soetomo General Hospital Surabaya. This research was carried out by a cross sectional study utilizing waste sputum samples from HIV and AIDS patients. The detection of Pneumocystis jerovecii used Giemsa stain. Six sputum samples among 18 sputum samples (33.33%) HIV and AIDS patients were Pneumocystis jerovecii positive. Based on this findings HIV and AIDS patients with pulmonary symptoms should be suspect having the possibility of PCP as opportunity infection in HIV and AIDS existed, and there for the detection of the Pneumocystis jerovecii in sputum sample must becoming routinelycarried out in the laboratory examination for HIV and AIDS patients which also suffering pulmonary symptom.

Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Background: Sputum is a non-invasive, economic investigation whereby bronchogenic carcinoma can be identified. Manual cytological screening is labour intensive, time-consuming and requires a continuous high level of alertness. Automation has recently been successfully introduced in gynaecological cytology. Since sputum samples are similar to cervical smears, the question arises as to whether they are also suitable for automated screening. Objective: This study presented with various objectives: 1) To test automated sputum screening using the BD FocalPoint™ Slide Profiler (FP) and compare with manual sputum screening. 2) To determine the sensitivity and specificity of sputum in identification of bronchogenic carcinoma. 3) To ascertain if any clinical, radiological or bronchoscopy findings would be predictors for bronchogenic carcinoma. 4) To determine the significance of adequacy. Method: Sputum samples were collected prospectively from patients attending the Division of Pulmonology at Tygerberg hospital for a transbronchial fine needle aspiration biopsy (TBNA) or a transthoracic fine needle aspiration biopsy (TTNA) for the period from 2010 to 2012. A pre-bronchoscopy sputum was collected and submitted for processing. Stained slides were put through the FP for automated screening. After slides were qualified, sputum slides were put back in the routine screening pool. Correlation was done using the TBNA/TTNA result as the standard to evaluate the sputum results. Results: 108 sputum samples were included in this study. Of the 84.3% malignant (n=91) and 15.7% benign (n=17) cases confirmed with a diagnostic procedure, sputum cytology had a sensitivity of 38.5% (35/91 malignant cases), and a specificity of 100% (17/17 benign cases). Automated screening had a better sensitivity of 94.3% (33/35 positive sputum cases), while manual screening showed a sensitivity of 74.3% (26/35 positive sputum cases) when compared to the final sputum result. Individual parameters with a significant association with positive sputum included the presence of an endobronchial tumour, partial airway obstruction / stenosis, round mass, spiculated mass (negative association), loss of weight (negative association) and squamous cell carcinoma as the histological subtype. Adequacy was not as significant as hypothesised since 85.3% of true positive sputum, but also 65.5% of false negative sputum, had large numbers of alveolar macrophages present. Conclusion: Sputum cytology remains an important part of the screening programme for bronchogenic carcinoma in the public health sector of South Africa. Results confirm that sputum cytology is very specific, and automated screening improves sensitivity. Automated screening proved to be more time efficient, resulting in 83.1% reduction (p<0.0001) in the screening time spent per case by a cytotechnologist. Results confirm that the quantity of alveolar macrophages is not directly proprtional to pathology representation. Positive sputum results did however improve with sputum adequacy, but had no significant association. Recommendations from this study include adopting automated sputum screening.
AFRIKAANSE OPSOMMING: Agtergrond: Die verkryging van ‘n sputummonster is ‘n nie-indringende, ekonomiese ondersoek waardeur bronguskarsinoom identifiseer kan word. Nie-geoutomatiseerde sitologiese ondersoek is arbeidsintensief, tydrowend en vereis ‘n deurlopende hoë vlak van konsentrasie en fokus. Outomatisering is onlangs suksesvol geïmplementeer in ginekologiese sitologie-ondersoeke. Aangesien sputummonsters soortgelyk aan servikale monsters is, het die vraag ontstaan of sputummonsters ook geskik sou wees vir geoutomatiseerde sifting. Doelwit: Hierdie studie het verskeie doelwitte gehad: 1) Om geoutomatiseerde sifting van sputummonsters te toets deur gebruik te maak van BD Focal Point ™ Slide Profiler (FP), en te vergelyk met nie-geoutomatiseerde sputum sifting. 2) Om die sensitiwiteit en spesifisiteit van sputum in die identifikasie van bronguskarsinoom te bepaal. 3) Om vas te stel of enige kliniese, radiologiese of brongoskopiese bevindings bronguskarsinoom sou kon voorspel. 4) Om die belang van ‘n verteenwoordigende monster te bepaal. Metode: ‘n Prospektiewe studie van die pasiënte wat die Divisie van Pulmonologie by Tygerberg Hospitaal vir transbrongiale nodale aspirasie (TBNA) of ‘n transtorakale aspirasie (TTNA) vanaf Julie 2010 tot Mei 2012 bygewoon het, is gedoen. ‘n Prebrongoskopiese sputum is geneem en gestuur vir prosessering. Die gekleurde skuifies is deur die FP gestuur vir geoutomatiseerde ondersoek. Indien die sputumskuifies gekwalifiseer het vir geoutomatiseerde sifting, is hulle in die groep vir ondersoek ingesluit. ‘n Korrelasiestudie, om die sputumresultate te evalueer, is uitgevoer deur die TBNA/TTNA bevindings as standaard te gebruik. Resultate: Vir hierdie studie is 108 sputummonsters ingesluit. Vanuit die 84.3% maligne (n=91) en 15.7% benigne (n=17) gevalle, bevestig deur ‘n diagnostiese prosedure, het sputumsitologie ‘n sensitiwiteit van 38.5% (35/91 maligne gevalle) en ‘n spesifisiteit van 100.0% (17/17 benigne gevalle), getoon. Geoutomatiseerde sifting het ‘n beter sensitiwiteit met 94.3% (33/35 maligne gevalle), terwyl nie-geoutomatiseerde (ondersoek) ‘n sensitiwiteit van 74.3% (26/35 maligne gevalle) wanneer met die finale resultaat vergelyk, gevind. Individuele parameters met ‘n betekenisvolle assosiasie het die teenwoordigheid van ‘n endobrongiale tumor, gedeeltelike lugwegobstruksie / stenose, ronde massa, ‘n spekuleerde massa (negatiewe assosiasie), gewigsverlies (negatiewe assosiasie) en plaveiselkarsinoom as die histologiese subtipe, ingesluit. Geskiktheid van die monster was nie so betekenisvol as wat in die hipotese gestel is nie: aangesien 85.3% van ware positief gediagnoseerde sputummonsters, maar ook 65.5% van die vals negatiewe sputummonsters, groot hoeveelhede alveolêre makrofae ingesluit het. Gevolgtrekking: Sputumsitologie bly steeds ‘n belangrike deel van die siftingsprogram vir bronguskarsinoom in die openbare gesondheidssektor in Suid-Afrika. Resultate van hierdie studie bevestig dat sputumsitologie baie spesifiek is en dat geoutomatiseerde sifting die sensitiwiteit verbeter. Ge-outomatiseerde sifting het bewys dat dit meer tydsbesparend is, met ‘n 83.1% vermindering (p<0.0001) in die siftingstyd wat deur een sitotegnoloog per geval bestee word. Resultate het bevestig dat die hoeveelheid alveolêre makrofae nie direk proporsioneel verwant is tot die patologie nie. Hoe meer verteenwoordigend die sputummonster was, hoe groter was die kanse om ‘n akkurate positiewe diagnose te maak. Die assosiasie van die geskiktheid van die sputummonster en die positiewe resultate het egter nie ‘n statisties betekenisvolle resultaat getoon nie. Aanbevelings vir hierdie studie sluit in die aanwending van geoutomatiseerde sputumondersoeke.

An infectious disease, as the name implies, is caused by pathogenic microorganisms such as bacteria, viruses, parasites, and fungi, and it spreads from one person to another through various ways, directly or indirectly. Most, but not all, of such diseases present to the ED with fever. Septic shock, respiratory failure, or central nervous system involvement may occur following an infection and threaten life. Such a situation presenting with tachycardia, reduced BP, tachypnoea, or depressed GCS requires immediate assessment and resuscitation. Following the principles of ABCDE, promptly carry out airway protection, oxygenation, and IV access with collection of blood samples for investigations, and fluid resuscitation. The aetiology of fever may be wide ranging, but a careful history and a detailed physical examination should help in determining the cause in majority of cases presenting to the ED. In addition to this, the initial investigations may help further in establishing the diagnosis. In elderly patients, the source of such infections may be the respiratory system, the genitourinary system or the involvement of the soft tissues, and they are often serious. In the otherwise healthy younger patient, one must keep in mind the other systems such as the central nervous system, as well as abdominal and soft tissue infections. Patients may often present in septic shock. Even if the cause of a fever may not be evident at the outset, the best ‘guestimate’ often helps in determining which antibiotics to start with, which should be given as soon as the culture samples have been collected. One must make every effort to collect appropriate samples of body fluids (blood, urine, stool, sputum, etc.) to find the source of infection so that targeted antimicrobial therapy may be started if the empirical treatment has not worked. A discussion with the on-call microbiologist to properly direct the empirical antibiotic therapy is often most rewarding. A patient with an infectious disease may put others at risk as well, resulting in devastating effects, particularly in hospitals.

According to examination and follow-up results of 5485 HIV-positive hospitalized patients (3333 of which were diagnosed with AIDS) we have identified the frequency of clinically evident CMV-infection as well as the frequency and character of CMV related lung disease. Statistically significant correlation between viral load, degree of immunosuppression, CMV replication rate and CMV pneumonia development risk has been determined. Qualitative PCR assay for CMV DNA in plasma and respiratory samples was found to have high sensitivity and low specificity for diagnosing CMV-pneumonia. We identified quantitative PCR CMV DNA values in blood cells, plasma, bronchoalveolar lavage, bronchi samples and sputum that confirm the diagnosis of CMV pneumonia with 95% and 99% probability, and exclude CMV related lung damage in HIV patients with 90% and 99% probability.