Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis - Experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil

Many patients with suspected pulmonary tuberculosis (PTB) do not produce sp utum spontaneously or are smear-negative for acid-fast bacilli (AFB). We pr ospectively compared the yield of sputum induction (SI) and fiberoptic bron choscopy with bronchoalveolar lavage (BAL) for the diagnosis of PTB in a re gion with a high prevalence of tuberculosis and human immunodeficiency viru s (HIV) infection. Fifty seven percent (143 of 251) of patients had diagnos es of PTB, of whom 17% (25 of 143) were HIV seropositive. There were no sig nificant differences in the yields of AFB smears or cultures whether obtain ed via SI or BAL Among 207 HIV-seronegative patients, the AFB smear and myc obacterial culture results from specimens obtained by SI and BAL were in ag reement in 97% (202 of 207) (kappa test = 0.92) and 90% (186 of 207) (kappa test = 0.78), respectively. Among HIV-seropositive patients the agreements between AFB smear and culture results for SI and BAL specimens were 98% (4 3 of 44) (kappa test = 0.93) and 86% (38 of 44) (kappa test = 0.69), respec tively. We conclude that SI is a safe procedure with a high diagnostic yiel d and high agreement with the results of fiberoptic bronchoscopy for the di agnosis of PTB in both HIV-seronegative and HIV-seropositive patients.