{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T22:18:02Z","timestamp":1792707482726,"version":"4.5.0"},"reference-count":32,"publisher":"European Respiratory Society (ERS)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2013,2,12]]},"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:p>\n                    Sputum induction can aid tuberculosis (TB) diagnosis, but adult data from HIV-endemic environments are limited, and it is unclear how performance varies depending on the clinical context (in-patient\n                    <jats:italic>versus<\/jats:italic>\n                    outpatient), HIV status and whether patients are smear-negative or sputum-scarce.\n                  <\/jats:p>\n                  <jats:p>\n                    696 adults with suspected smear-negative or sputum-scarce TB from Cape Town (South Africa) were referred for routine sputum induction. Liquid culture for\n                    <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                    served as the reference standard.\n                  <\/jats:p>\n                  <jats:p>\n                    82% (573 out of 696) of patients provided a specimen \u22651 mL, 83% (231 out of 278) of which were of adequate quality. 15% (96 out of 652) of sputum induction specimens were culture-positive, and this yield was higher among inpatients\n                    <jats:italic>versus<\/jats:italic>\n                    outpatients (17% (71 out of 408)\n                    <jats:italic>versus<\/jats:italic>\n                    10% (25 out of 244), p=0.01) and HIV-infected\n                    <jats:italic>versus<\/jats:italic>\n                    uninfected patients (17% (51 out of 294)\n                    <jats:italic>versus<\/jats:italic>\n                    9% (16 out of 173), p=0.02), but similar for CD4 (&gt;200\n                    <jats:italic>versus<\/jats:italic>\n                    \u2264200 cells\u00b7\u03bcL\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) and patient (smear-negative\n                    <jats:italic>versus<\/jats:italic>\n                    sputum-scarce) subcategories. Overall sensitivity (95% CI) of smear-microscopy was 49% (39\u201359%), higher among in-patients\n                    <jats:italic>versus<\/jats:italic>\n                    outpatients (55% (43\u201367%)\n                    <jats:italic>versus<\/jats:italic>\n                    32% (14\u201350%), p=0.05), but unaffected by HIV co-infection, CD4 count or patient type. 29% (203 out of 696) of patients commenced anti-TB treatment and sputum induction offered microbiological confirmation and susceptibility testing in only 47% (96 out of 203).\n                  <\/jats:p>\n                  <jats:p>Under programmatic conditions in an HIV-endemic environment although the yield of culture was approximately two-fold higher amongst HIV-infected patients and inpatients, a fifth of all patients were unable to provide a specimen following sputum induction. Same-day microbiological diagnosis was only possible in \u223c50% of patients.<\/jats:p>","DOI":"10.1183\/09031936.00198012","type":"journal-article","created":{"date-parts":[[2013,3,21]],"date-time":"2013-03-21T23:18:01Z","timestamp":1363907881000},"page":"185-194","source":"Crossref","is-referenced-by-count":45,"title":["Sputum induction to aid diagnosis of smear-negative or sputum-scarce tuberculosis in adults in HIV-endemic settings"],"prefix":"10.1183","volume":"43","author":[{"given":"Jonathan G.","family":"Peter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Theron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevanda","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avani","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keertan","family":"Dheda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2013,3,21]]},"reference":[{"key":"2024102021372806000_43.1.185.1","first-page":"741","article-title":"Extra-pulmonary and smear-negative forms of tuberculosis are associated with treatment delay and hospitalisation","volume":"14","author":"Whitehorn","year":"2010","journal-title":"Int J Tuberc Lung Dis"},{"key":"2024102021372806000_43.1.185.2","unstructured":"World Health Organization. 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