Examination Of Induced Sputum Research Articles

Characteristics of inflammatory phenotypes in patients with chronic obstructive pulmonary disease: a cross-sectional study

BackgroundThe relationship between airway inflammation in chronic obstructive pulmonary disease (COPD) and clinical characteristics remains unclear. This study aimed to investigate the airway inflammatory phenotypes in COPD and their association...

Cavitating Consolidation with Acute Febrile Respiratory Illness & ‘Sister Cavities’ Without Typical Constitutional Symptoms in Pulmonary Tuberculosis: A Rare But Possible!

Community acquired pneumonia is the most common cause for lung parenchymal infiltrates in chest radiograph in scenarios with acute febrile respiratory illness. Tuberculosis in India accounts for the highest number of cases and deaths in the world. In spite of an efficient National tuberculosis control program for five decades, Tuberculosis is still the number one cause of death due to infectious agents in India and one third of total global deaths occurs in India due to this disease. Tuberculosis may present with consolidation, cavitation, coin lesion, parenchymal infiltrates and hilar mass like lesions. Acute febrile respiratory illness without typical constitutional symptoms is not frequently described in pulmonary tuberculosis. In this case report, a 69-year male, presented with acute febrile respiratory illness of short duration. He was having high grade fever, cough, shortness of breath & haemoptysis of less than two weeks duration. His symptoms were progressive and empirically treated as lower respiratory tract infection or community acquired pneumonia with oral and intravenous antibiotics by general physicians and family physicians. Family physician referred to our center for worsened general health with increased shortness of breath with episodes of minimal haemoptysis. Chest x-ray documented right lower lobe consolidation which has progressed to central cavitations and thick pericavitary rim of consolidation mimicking lung abscess. Clinically he was having crepitations in the right inframammary and infrascapular area with egophony heard. HRCT thorax showed consolidation with cavitation in the superior segment of the right lower lobe and adjacent small cavity in the posterior segment presenting as a ‘Sister cavity’ accompanying a large parent cavity. He was unable to produce sputum and we have processed induced sputum examination which has documented acid-fast bacilli in smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Initially, microbiologists refused for smear preparation due to salivary nature and poor-quality sputum. We have insisted for microbiology workup due to high chances of yield due to cavitary lung disease and noted positive yield. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. Acute febrile respiratory illness and absence of typical constitutional symptoms is not uncommon. Although cavitating consolidation is commonly described in community acquired pneumonia, presence of ‘sister cavity’ is a radiological clue to think and proceed to workup towards active pulmonary tuberculosis. Induced sputum has a very significant impact on diagnostic yield. Pulmonary tuberculosis should be suspected early in cases with cavitating consolidations to have a successful treatment outcome.

Sputum Eosinophil Level among Healthy Individuals Visiting Medicine Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Sputum differential is the most comprehensive, and non-invasive investigation for evaluating airway inflammation because of its reliability, reproducibility and responsiveness. The interpretation of the results of induced sputum examination depends on knowledge of normal values from a healthy population. So far, the reference values of sputum differential cells in Nepalese population are not reported. Neutrophil and eosinophil are used to assess the inflammatory response of the airway. The aim of our study was to detect the eosinophil level in the sputum of healthy individuals with normal pulmonary function. A descriptive cross-sectional study was conducted in a tertiary care hospital, from November 1, 2021 to December 31, 2021 after taking ethical clearance from Institutional Review Board (Reference number: 1507202106). Convenience sampling was done. Collected data was entered and analysed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% was calculated along with mean and standard deviation for continuous data. Among 139 induced sputum samples, 7 (5.03%) had eosinophils present in their sputum (1.40 to 8.67 at 95% Confidence Interval). The age range of the participants was 18 years to 79 years with mean age of 39.5 ± 15.06. Prevalence of eosinophilia (percentage of eosinophil ≥3) was 4 (2.88%). The prevalence of eosinophilia in our study was found to be similar to published literature. The results of the present study show that there is a paucity of eosinophils with predominance of neutrophils, macrophages and lymphocytes in induced sputum samples of healthy non-smoker adults with normal pulmonary function test. eosinophils; healthy volunteers; leukocyte count; reference values; sputum.

TO STUDY THE CLINICAL, RADIOLOGICAL AND MICROBIAL PROFILE OF PULMONARY INFECTION IN IMMUNOCOMPROMISED PATIENTS

BACKGROUND The lung is one of the most frequently involved organs in complications of immunocompromised host. Among these, pulmonary infection is the most common complication. The chest radiograph is initial diagnostic tool for detection of suspected pulmonary infection in immunocompromised. However, chest radiograph ndings are nonspecic in determining pathogens. The early use of Computed Tomography (CT) is helpful in detecting pulmonary lesions which may not be evident on routine chest radiographs. But there is overlap of CT nding in different infections. This study is therefore, designed to document the clinical, radiological & microbial prole of pulmonary infection in immunocompromised patients. AIM To study the clinical, radiological and microbial prole of pulmonary infection in immunocompromised patients, and to study diagnostic yield of sputum examination, induced Sputum examination & bronchoscopic BAL examination. METHODS The present prospective descriptive observational study was conducted in the Department of Chest Medicine at King Edward Memorial Hospital, Pune. It included immunocompromised patients with lower respiratory tract infection symptoms. A total number of 70 indoor & OPD patient with urban & rural background were included in the study. Among them 45 patients were HIV reactive group and 25 patients were having Non-HIV immunocompromised condition. All of them had pulmonary infection. The study was conducted over a period of 15 months. RESULTS Incidence of pulmonary infection was higher in age 31-40 years (28.58%). There were 51 males and 19 females. Opportunistic infections were more common in males as compared to females. Majority of immunocompromised patients were HIV reactive (64.3%) followed by of Malignancy (15.7%). Focal non homogenous opacity (37.5%) was most common radiological nding followed by consolidation with air brochogram (25%). Pulmonary Tuberculosis (40.5%) was most common opportunistic infection in immunocompromised patients followed by bacterial (30.38 %) and fungal infections (17.72%). Sputum (40.98), induced sputum examination (19.29), and Bronchoscopy with BAL (91.42%) had good diagnostic yield in diagnosis of pulmonary infection in immunocompromised patients. CONCLUSION Induced sputum had less diagnostic yield in immunocompromised patients and also it is time consuming.Early bronchoscopy with BAL remains crucial to establish the diagnosis in immunocompromised patients with pulmonary infection when the cause is infectious in nature.

PNEUMONIA IN AN IMMUNOCOMPROMISED PATIENT: DIAGNOSTIC AND THERAPEUTIC CHALLENGES

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pneumocystis jirovecii can cause life-threatening pneumonia in immunocompromised patients. A significant number of HIV-positive patients are still affected, including those not yet diagnosed with HIV and those not taking antiretroviral therapy or prophylaxis. Diagnosis and treatment often present challenges. CASE PRESENTATION: A 39 year-old man presented with several weeks of worsening shortness of breath and pleuritic chest pain. He was mildly tachypneic, and oxygen saturation decreased to 80% upon ambulation. He was found to be HIV positive with a CD4 count of 9. Serum beta-D-glucan and lactate dehydrogenase levels were elevated. PaO2 was 64 mmHg with an alveolar-arterial gradient of 35 mm Hg. Calcofluor white (CW) stain of induced sputum was negative. Chest radiography showed increased perihilar interstitial markings. Computed tomography showed septal thickening with scattered ground glass opacities. Bronchoscopy with bronchoalveolar lavage (BAL) was performed. BAL CW stain and Pneumocystis polymerase chain reaction (PCR) were positive. He was treated with trimethoprim-sulfamethoxazole (TMP-SMX) and steroids and developed hyperkalemia. He was switched to primaquine and clindamycin with a plan for 21 days of therapy. DISCUSSION: Traditional diagnostic testing for PCP relied on staining and visualization of organisms in BAL fluid. The sensitivity of non-immunofluorescent stains such as CW ranges from 31-97% depending on sample quality and stain interpretation. Many centers have started to utilize sputum staining for diagnosis of PCP, but as our case demonstrates, this is not adequate to rule out PCP in patients for whom there is high clinical suspicion. BAL fluid has greater sensitivity than sputum testing, and bronchoscopy after negative sputum testing yields the diagnosis in 51% of cases. PCR on BAL fluid is the best test for detection with 97-99% sensitivity. Unfortunately, no PCR-based diagnostic methods have been approved to date by the FDA. TMP-SMX remains the first line treatment for PCP. Its side effect profile includes hyperkalemia, hypersensitivity reactions, hepatitis, myelosuppression, and interstitial nephritis. Because toxicity necessitates a change in therapy in up to 17% of patients, it is crucial to be familiar with second line treatments such as pentamidine, atovaquone, and clindamycin-primaquine. Clindamycin-primaquine was chosen for our patient, as it has been shown to lead to higher clinical response and survival rates than pentamidine. Corticosteroids should be used as an adjunct therapy if PaO2 is under 70 mmHg on room air or the alveolar-arterial gradient is greater than 35, as this can improve outcomes in HIV-positive patients. CONCLUSIONS: Practitioners should not rely on negative sputum testing if clinical suspicion for PCP is high. Patients should be monitored for side effects of TMP-SMX and switched to an alternative regimen if necessary. Reference #1: Bateman ME, Oladele R, Kolls JK. Diagnosing Pneumocystis jirovecii Pneumonia: A Review of Current Methods and Novel Approaches. Medical Mycology. 2020. PMID: 32400869. Doi: 10.1093/mmy/myaa024. Reference #2: Cruciani M, Marcati P, Malena M, et al. Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1 infected patients. European Respiratory Journal. 2002; 20: 982-989. Reference #3: Huang L, Hecht FM, Stansell JD, et al. Suspected pneumocystis carinii pneumonia with a negative induced sputum examination. Is early bronchoscopy useful? American Journal of Respiratory and Critical Care Medicine. 1995; 151: 1866-1871. DISCLOSURES: No relevant relationships by Marjorie Bateman, source=Web Response No relevant relationships by JENNIFER CHIURCO, source=Web Response

Annual decline in forced expiratory volume and airway inflammatory cells and mediators in a general population-based sample

BackgroundFew studies have examined the relationships between sputum inflammatory markers and subsequent annual decline in forced expiratory volume in 1 s (dFEV1). This study investigated whether indices of airway inflammation are predictors of dFEV1 in a general population-based sample.MethodsThe study, conducted from 2003 to 2005, included 120 healthy Norwegian subjects aged 40 to 70 years old. At baseline, the participants completed a self-administered respiratory questionnaire and underwent a clinical examination that included spirometry, venous blood sampling, and induced sputum examination. From 2015 to 2016, 62 (52%) participants agreed to a follow-up examination that did not include induced sputum examination. Those with a FEV1/forced vital capacity (FVC) ratio < 0.70 underwent a bronchial reversibility test. The levels of cytokines, pro-inflammatory M1 macrophage phenotypes were measured in induced sputum using bead-based multiplex analysis. The associations between cytokine levels and dFEV1 were then analysed.ResultsThe mean dFEV1 was 32.9 ml/year (standard deviation 26.3). We found no associations between dFEV1 and the baseline indices of sputum inflammation. Seven participants had irreversible airflow limitation at follow-up. They had lower FEV1 and gas diffusion at baseline compared with the remaining subjects. Moreover, two of these individuals had a positive reversibility test and sputum eosinophilia at baseline.ConclusionsIn this cohort of presumably healthy subjects, we found no associations between sputum inflammatory cells or mediators and dFEV1 during 10 years of follow-up.

KAAACI Standardization Committee report on the procedure and application of induced sputum examination

This research was supported by a fund (A092076) by Research of Korea Centers for Disease Control and Prevention.

The success and safety profile of sputum induction in patients with chronic obstructive pulmonary disease: An Indian experience

BackgroundNeutrophilic inflammation is common in chronic obstructive pulmonary disease while Asthma COPD overlap syndrome has eosinophilic predominance. Identifying the type of inflammation will aid in better management of COPD, but published studies show that induced sputum examination is more frequently used in asthma than COPD, with safety being the limiting factor. We aimed to determine the success and safety of sputum induction (SI) in COPD patients. Methods116 stable COPD patients underwent SI. Success was defined as adequate sputum sample resulting in a cytospin sufficient to assess differential count while safety by the fall in FEV1. ResultsThe mean (SD) FEV1% predicted post bronchodilator was 58.8 (17.8) and 59 (51.8%) patients had moderate COPD. Success was 98.28%. The procedure was safe with overall fall in FEV1 of 11.1% (5.1, 15.2). ≥20% fall was noted in 13 (11.4%) patients, 10–20% in 24 (21.0%) patients, and less than 10% in 29 (25.4%) patients while 48 (42.1%) had no fall. There was an inverse correlation between reversibility in FEV1 and percentage fall in FEV1; r=−0.437 and p=0.001. Stepwise multivariate linear regression showed reversibility as an independent predictor of fall in FEV1; R2=0.137. ConclusionsSputum induction is successful and safe in COPD. Even a fall in FEV1>20% is reversible.

Effect of micronutrient deficiency on QuantiFERON-TB Gold In-Tube test and tuberculin skin test in diagnosis of childhood intrathoracic tuberculosis

Data on performance of QuantiFERON-TB Gold In-Tube test (QFT) and tuberculin skin test (TST) in children with active tuberculosis from high burden countries in the context of micronutrient deficiency are scarce. The objective of this study was to evaluate the effect of micronutrient deficiency on the performance of TST and QFT in children with intrathoracic tuberculosis. Children with probable intrathoracic tuberculosis underwent TST, QFT, gastric lavages and induced sputum examination for AFB (Acid-Fast Bacilli) smear and culture. Zinc, copper, ferritin and vitamin D were measured on stored serum samples. The study used cross-sectional data at initiation of anti-tubercular therapy. Three hundred and sixty-two children (median age 115.5 months (interquartile range: 73, 144), 200 (55.3%) girls) were enrolled in the study. Microbiological confirmation of tuberculosis could be obtained in 128 patients. TST and QFT were positive in 337 (93%) and 297 (82%) children, respectively. Performance of both the tests was unaffected by weight-for-age and height-for-age 'z-scores' or by serum copper levels. TST was not affected by serum zinc and ferritin levels. Children with negative QFT results had lower mean serum zinc level (P=0.01) and higher ferritin levels (P=0.007) as compared to those with positive test. Higher proportion of children with positive TST were vitamin D deficient/insufficient (P=0.003). Micronutrient status, especially serum levels of zinc, may influence the performance of QFT in children with intrathoracic tuberculosis. Considering the high prevalence of zinc deficiency in developing countries, QFT should be used cautiously for diagnosing tuberculosis.

Blood (1-&gt;3)- -D-Glucan as a Diagnostic Test for HIV-Related Pneumocystis jirovecii Pneumonia

(See the editorial commentary by Morris and Masur, on pages 203-204.) Improved noninvasive diagnostic tests for Pneumocystis jirovecii pneumonia (PCP) are needed. We evaluated the test characteristics of plasma (1 → 3)-β-D-glucan (β-glucan) for HIV-related PCP among a large group of patients presenting with diverse opportunistic infections (OIs). The study population included all 282 participants in AIDS Clinical Trials Group A5164, a study of early versus deferred antiretroviral therapy in conjunction with initial therapy of acute OIs. Baseline plasma samples were assayed for β-glucan, with standard assay reference values defining ≥ 80 pg/mL as positive. Before this analysis, diagnosis of PCP was independently adjudicated by 2 study investigators after reviewing reports from study sites. A total of 252 persons had a β-glucan result that could be analyzed, 173 (69%) of whom had received a diagnosis of PCP. Median β-glucan with PCP was 408 pg/mL (interquartile range [IQR], 209-500 pg/mL), compared with 37 pg/mL (IQR, 31-235 pg/mL) without PCP (P < .001). The sensitivity of β-glucan dichotomized at 80 pg/mL for the diagnosis of PCP was 92% (95% confidence interval [CI], 87%-96%), and the specificity was 65% (95% CI, 53%-75%); positive and negative predictive values were 85% (95% CI, 79%-90%) and 80% (95% CI, 68%-89%) respectively, based on the study prevalence of 69% of patients with PCP. Rates of abnormal lactate dehyrogenase levels did not differ significantly between those with and without PCP. Blood (1 → 3)-β-D-glucan is strongly correlated with HIV-related PCP. In some clinical centers, this may be a more sensitive test than the induced sputum examination and could reduce the need for both bronchoscopy and empirical therapy of PCP.

The Usefulness of Induced Sputum Examination in the Diagnostic Evaluation of Selected Chronic Inflammatory Diseases of the Respiratory Tract

Usefulness of the cytological analysis in diagnostics some of chronic inflammatory diseases of the respiratory system was assessed on the basis of the normal values for the composition of sputum inflammatory cells among healthy inhabitants of Silesia. Examined: 96 healthy subjects (control group), 42 patients with bronchial asthma, 49 patients with chronic obstructive pulmonary disease (COPD) and 30 patients with chronic bronchitis (CB). Spirometry, before and 15 minutes after 200 micrograms of salbutamol, and sputum examination were performed in all participants. Airway responsiveness on metacholine was performed in people with no contraindication. In comparison to the control group, the percentage of eosinophils was significantly higher in all patients (p<0.00001). Median values were following: asthma patients--10.3%, COPD patients--1.5%, CB patients--1.6% and control subjects--0.3%. Important statistic differences (p<0.05%) have been observed in the average percentage of the neutrophils in induced sputum between healthy subjects and patients with asthma, COPD and CB. Respective median values were: 45.75%, 38.1%, 77.5% and 58.1%. The percentage of patients whose sputum eosinophils results were above the normal values (>2.8%) was as follows: 85% of the number of patients with bronchial asthma, 38% of patients with COPD, 20% of patients with CB and 6% of healthy subjects. These results suggest that cytological examination of induced sputum is a good adjunctive test in diagnostics of the chronic inflammatory diseases of the respiratory system. The percentage of eosinophils in induced sputum above 2.8% most probably confirms bronchial asthma diagnosis.

Exhaled Nitric Oxide Measurement Is Useful for the Exclusion of Nonasthmatic Eosinophilic Bronchitis in Patients With Chronic Cough

Nonasthmatic eosinophilic bronchitis (NAEB) is an important cause of chronic cough, and it can be diagnosed by an induced-sputum (IS) examination. However, an IS examination is a complex and time-consuming procedure, and it has limited clinical application. This study aimed to evaluate the role of exhaled nitric oxide (NO) for the investigation of chronic cough, especially of NAEB. Two hundred eleven nonsmoking patients with a cough lasting > 3 weeks were enrolled in the study. The patients were examined and investigated with conventional diagnostic tools, including an IS examination. Exhaled NO was measured by a chemoluminescent analyzer. One hundred seventeen patients with adequate IS results were analyzed: asthma, n = 14; NAEB, n = 21; and "others," n = 82. Exhaled NO and IS eosinophils were significantly higher in the asthma group and NAEB group than in the others group. Exhaled NO and IS eosinophils were significantly correlated in the asthma and NAEB groups. In the nonasthmatic group, the sensitivity and specificity of exhaled NO for detecting NAEB, using 31.7 parts per billion as the exhaled NO cutoff point, were 86% and 76%, respectively. Positive and negative predictive values were 47% and 95%, respectively, and positive and negative likelihood ratios were 3.51 and 0.19, respectively. We concluded that exhaled NO measurement may be useful as part of the initial evaluation for chronic cough, especially for the exclusion of NAEB. A low level of exhaled NO suggested little likelihood of NAEB for the nonasthmatic patients with chronic cough.

Induced Sputum in Systemic Sclerosis Interstitial Lung Disease: Comparison to Healthy Controls and Bronchoalveolar Lavage

Background: Induced sputum (IS) is a noninvasive tool, which can be used to collect cellular and soluble materials from lung airways. Objective: To evaluate if IS may be a useful and safe tool for the detection of airway inflammation in patients with interstitial lung disease (ILD) in systemic sclerosis (SSc). Methods: Sixty-eight patients with SSc and ILD as well as 18 healthy individuals (controls) were selected and submitted to IS examination. In 34 of 68 patients with SSc, bronchoalveolar lavage (BAL) was also performed. Safety of IS was assessed by comparison of forced expiratory volume in the first second (FEV₁), FEV₁/forced vital capacity ratio and peak expiratory flow before and after the IS procedure. Cell composition in samples collected by BAL and IS was correlated, and IS total and differential cell count in SSc patients and controls were compared. Results: The total number of cells was significantly higher in IS samples of SSc patients compared to those of healthy controls. Mean percentage of neutrophils was also higher in SSc patients (41.79 ± 23.89 vs. 27.37 ± 17.90), as well as lymphocytes (17.42 ± 19.70 vs. 3.13 ± 2.28) and eosinophils (2.35 ± 4.43 vs. 0.41 ± 0.46). On the other hand, mean percentage of macrophages was higher in healthy individuals (69.10 ± 19.15 vs. 36.96 ± 20.68). In fluid recovered by BAL, the most frequent cells were macrophages (67.89% ± 17.26), while neutrophils (14.77 ± 17.18%) and lymphocytes (15.62 ± 13.46%) were less frequent and eosinophils (1.66 ± 2.08%) were rare. A similar pattern of cell composition was found in IS samples (41.15 ± 21.67% of macrophages, 39.72 ± 23.15% of neutrophils, 15.28 ± 19.46% of lymphocytes and 2.56 ± 5.03% of eosinophils). Strength of correlation between BAL and IS was significant for macrophages and neutrophils. After IS procedure was performed, improvement of FEV₁ (mean value before IS was 85.09 ± 14.44 and 88.93 ± 16.40 after IS) and FEV₁/forced vital capacity (mean value before IS was 98.53 ± 12.11 and 105.22 ± 10.78 after IS) was observed. Conclusion: The IS method may allow a noninvasive assessment of cell composition in airway fluid and may contribute to the better understanding of upper/medium airway inflammation in SSc. Future studies are needed to verify whether IS can replace invasive procedures for the detection and monitoring of lung inflammation in SSc.

Causes and Clinical Features of Subacute Cough

Cough lasting > 3 weeks has been defined as chronic cough. However, it might be more persuasive to divide cough into subacute, lasting 3 to 8 weeks, and chronic, lasting > 8 weeks. We evaluated the causes and clinical courses of subacute cough, and the value of the bronchoprovocation test and induced sputum examination (IS). Nonsmoking patients with cough of 3 to 8 weeks duration were enrolled into the study. Patients with dyspnea, basal FEV1 of < 70% predicted, abnormal findings on a plain chest radiograph or physical examination were excluded. We prescribed an antihistamine-decongestant for patients who were suspected to have postinfectious cough or postnasal drip. If patients had positive results on a bronchoprovocation test or IS, therapy with inhaled corticosteroids was substituted according to an algorithmic approach. One hundred eighty-four patients (77 men and 107 women) were evaluated; the mean age of the study group was 47.5 years. Eighty-nine of 184 patients had postinfectious cough. Cough resolved without treatment in 62 patients. Twenty-nine of 43 patients with positive bronchoprovocation test results had cough-variant asthma. Postinfectious cough was the most common cause of subacute cough. The spontaneous resolution of cough was frequent in patients with subacute cough. Unless asthma was strongly suspected, the performance of the bronchoprovocation test could be delayed until after empirical treatment had been administered.

Lung Cancer Screening Using Multi-Slice Thin-Section Computed Tomography and Autofluorescence Bronchoscopy

Thoracic computed tomography (CT) for lung cancer screening is sensitive for the detection of early peripheral lung cancer but is not sensitive for detecting central preinvasive and microinvasive cancer. Our hypothesis is that the use of a two-step strategy, using a sputum biomarker, may increase the detection rate of lung cancer by identifying individuals at highest risk. We completed a pilot study of 561 volunteer current or former smokers 50 years of age or older, with a smoking history of more than or equal to 30 pack years. All subjects received induced sputum examination and low-dose thoracic CT scan and were offered autofluorescence bronchoscopy. CT detected 2408 pulmonary nodules, 80% of which were less than or equal to 4 mm in diameter. During 2-year follow-up, 95% of these nodules were stable or resolved, with only 4% showing growth at any time. A total of 28 cancers were detected in 22 subjects: 21 by CT scan and seven by autofluorescence bronchoscopy. Overall, 0.9% nodules were malignant, but growth on more than or equal to two CT scans increased the malignancy rate to 75%. The mean diameter of malignant nodules on detection was 12.8 mm (range, 3 to 36.4 mm). However, 18% of malignant nodules were less than or equal to 4 mm in diameter when first seen. Multi-detector row CT scanners found multiple small nodules in most subjects screened, but most were stable over the 2-year follow-up. Persistent interval growth increases the probability of malignancy from less than 1% to 75%. One quarter of detected cancers were CT occult and only seen with autofluorescence bronchoscopy. Prescreening using a sputum biomarker improved the detection rate of lung cancer from 3 to 5%.

Induced sputum for identifying sarcoidosis in patients with uveitis

Objective To evaluate the value of the induced sputum technique in diagnosing sarcoidosis as the cause of uveitis. Design Comparative case series. Participants Seventeen patients with uveitis. Two control groups were used. The first included 10 patients with sarcoid without uveitis; the second included 5 healthy volunteers. Testing Sputum was induced by a 20-minute inhalation of 3.5% saline using an ultrasonic nebulizer. Samples were studied by differential counts of 200 cells on cytopreps stained by Giemsa. T lymphocyte subset analyses were done by fluorescence-activated cell sorter using the monoclonal antibodies CD4 (T helper cells) and CD8 (T suppressor-cytotoxic cells). Angiotensin-converting enzyme (ACE) serum levels were obtained. Main outcome measures A CD4/CD8 ratio >2.5 and an ACE level >145 μl/ml/minute were considered to be abnormal. Results The difference in the CD4/CD8 ratios in the induced sputum examination between the group of patients with an elevated ACE level and the group of patients with an ACE level within normal limits was statistically significant ( P = 0.0001). Conclusions The induced sputum examination showed increased CD4/CD8 ratios in patients with uveitis who also had elevated ACE levels, suggesting the presence of sarcoidosis.

Induced Sputum, Eosinophilic Bronchitis, and Chronic Obstructive Pulmonary Disease

The application of sputum induction and refined methods of sputum examination has provided the opportunity to examine cell and molecular markers of airway inflammation in asthma, COPD, and other airway diseases. The measurements are relatively noninvasive and can be applied safely, with care, even in more severe exacerbations of asthma and severe COPD. Induced sputum examination can be applied at random and repeatedly and gives results that are reproducible, valid, and responsive to changes in treatment. An eosinophilic bronchitis, defined as sputum eosinophilia, is typical of asthma but can also occur in patients with a chronic cough without asthma, and in some patients with COPD in whom the classic inflammatory response is neutrophilic without eosinophilia. When eosinophilia occurs in COPD, it has been considered to be the result of cigarette smoking but it may be due to other causes. The clinical importance of eosinophilic bronchitis is that it responds to treatment with corticosteroid. In contrast, there is increasing evidence that an absence of sputum eosinophilia is associated with steroid resistance. Hargreave FE, Leigh R. Induced sputum, eosinophilic bronchitis, and chronic obstructive pulmonary disease.

Diagnosis of left-ventricular dysfunction from induced sputum examination

Diagnosis of left-ventricular dysfunction from induced sputum examination

Is Bronchoscopy Required in Patients with HIV Infection, Suspected Pneumocystis carinii Pneumonia, and Negative Induced Sputum Examination?. Con Bronchoscopy

Infectious Diseases Clinic, Division of Infectious Diseases and AIDS Center, Montefiore Medical Center, and Albert Einstein College of Medicine, Bronx, N. Y.

Is Bronchoscopy Required in Patients with Human Immunodeficiency Virus Infection, Suspected Pneumocystis carinii Pneumonia, and Negative Induced Sputum Examination? Pro

Is Bronchoscopy Required in Patients with Human Immunodeficiency Virus Infection, Suspected Pneumocystis carinii Pneumonia, and Negative Induced Sputum Examination? Pro