Safety and tolerability of sputum induction in adolescents and adults with suspected pulmonary tuberculosis |
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Authors: | H D Geldenhuys W Kleynhans N Buckerfield M Tameris Y Gonzalez H Mahomed G Hussey W Hanekom and M Hatherill |
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Institution: | (1) South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa;(2) School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa;(3) SATVI, Brewelskloof Hospital, Haarlem St., Worcester, 6850, South Africa |
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Abstract: | 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. |
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