{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:06:27Z","timestamp":1792616787804,"version":"4.5.0"},"reference-count":22,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health, with the \u201cRicerca Corrente\u201d grant of the IRCCS Research Program n.4 Tuberculosis"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Diagnosing non-tuberculous mycobacterial pulmonary disease (NTM-PD) in patients unable to produce sputum spontaneously requires invasive procedures to obtain valid respiratory specimens. In this retrospective study, we evaluated the results of microbiological tests performed on respiratory samples of 132 patients affected by NTM-PD. In the diagnostic workout, 98 patients performed both induced sputum (IS) and bronchoalveolar lavage (BAL) and were enrolled in our study. A total of 93 out of 98 BAL samples (95%) were culture-positive for mycobacteria, whereas only 67\/153 (44%) induced sputum cultures were positive for NTM (p &lt; 0.001). Molecular identification of NTM with real-time polymerase chain reaction (PCR) was positive in 48\/64 BAL (75%) and in 47\/139 (34%) IS samples (p &lt; 0.001). Patients affected by nodular-bronchiectatic form were 65\/98 (66%): BAL culture was positive in 95% of cases (62\/65 BAL), while only 30\/99 IS cultures were positive (30%; p &lt; 0.001). PCR was positive in 76% of BAL samples examined (26\/34) and in 26% of the IS samples (24 out of 91) (p &lt; 0.001). Among 33 patients with a fibro-cavitary radiological pattern, 65% of IS (35\/54) were culture-positive for NTM, whereas 94% of cases (31\/33) had a positive culture for NTM from BAL (p = 0.002). PCR was positive in 73% of BAL samples tested (22\/30) and 48% of IS samples tested (23\/48) (p = 0.031). Our results confirm BAL mycobacterial culture as the gold standard for the diagnosis of pulmonary mycobacteriosis. FBS with BAL should be performed in every patient with a strong suspicion of NTM-PD, if other respiratory samples are repeatedly negative. Sputum induction is a useful technique to obtain valid respiratory samples when patients are unable to produce spontaneous sputum, especially in the outpatient setting. However, during the diagnostic workup of NTM-PD, we should not forget that PCR and mycobacterial culture of induced sputum have a lower yield than when performed on BAL, especially in the nodular-bronchiectatic form of the disease.<\/jats:p>","DOI":"10.3390\/pathogens13121064","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T09:18:32Z","timestamp":1733217512000},"page":"1064","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Clinical Utility of Induced Sputum and Bronchoalveolar Lavage Cultures in Diagnosing Nontuberculous Mycobacterial Pulmonary Disease"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6238-3818","authenticated-orcid":false,"given":"Maria Angela","family":"Licata","sequence":"first","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8928-8183","authenticated-orcid":false,"given":"Paola","family":"Mencarini","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelisa","family":"Mastrobattista","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena Maria","family":"Carli","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Cerva","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Mosti","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Libertone","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Zolezzi","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Vittozzi","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-0437","authenticated-orcid":false,"given":"Carla","family":"Nisii","sequence":"additional","affiliation":[{"name":"Department of Microbiology, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6285-4368","authenticated-orcid":false,"given":"Antonio","family":"Mazzarelli","sequence":"additional","affiliation":[{"name":"Department of Microbiology, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Cannas","sequence":"additional","affiliation":[{"name":"Department of Microbiology, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-4312","authenticated-orcid":false,"given":"Assunta","family":"Navarra","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Ianniello","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging Unit for Infectious Diseases, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1067-4696","authenticated-orcid":false,"given":"Rocco","family":"Trisolini","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Division, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d IRCCS, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8360-4376","authenticated-orcid":false,"given":"Delia","family":"Goletti","sequence":"additional","affiliation":[{"name":"Translational Research Unit, National Institute for Infectious Diseases (INMI), \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8184-6291","authenticated-orcid":false,"given":"Fabrizio","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Gualano","sequence":"additional","affiliation":[{"name":"Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d IRCCS, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100244","DOI":"10.1016\/j.jctube.2021.100244","article-title":"Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease","volume":"24","author":"Pennington","year":"2021","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1164\/rccm.200604-571ST","article-title":"An Official ATS\/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases","volume":"175","author":"Griffith","year":"2007","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2000535","DOI":"10.1183\/13993003.00535-2020","article-title":"Treatment of nontuberculous mycobacterial pulmonary disease: An official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline","volume":"56","author":"Daley","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e000242","DOI":"10.1136\/bmjresp-2017-000242","article-title":"British Thoracic Society Guideline for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)","volume":"4","author":"Haworth","year":"2017","journal-title":"BMJ Open Respir. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1159\/000515605","article-title":"Bronchial brushing and diagnosis of pulmonary nontuberculous mycobacteria infection","volume":"100","author":"Urabe","year":"2021","journal-title":"Respiration"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Urabe, N., Sakamoto, S., Masuoka, M., Kato, C., Yamaguchi, A., Tokita, N., Homma, S., and Kishi, K. (2023). Efficacy of three sputum specimens for the diagnosis of Mycobacterium avium complex pulmonary disease. BMC Pulm. Med., 23.","DOI":"10.1186\/s12890-023-02327-5"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Gopalaswamy, R., Shanmugam, S., Mondal, R., and Subbian, S. (2020). Of tuberculosis and non-tuberculous mycobacterial infections\u2014A comparative analysis of epidemiology, diagnosis and treatment. J. Biomed. Sci., 27.","DOI":"10.1186\/s12929-020-00667-6"},{"key":"ref_8","first-page":"173","article-title":"Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis","volume":"58","author":"Prakash","year":"2016","journal-title":"Indian J. Chest Dis. Allied Sci."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Luo, W., Lin, Y., Li, Z., Wang, W., and Shi, Y. (2020). Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: A systemic review and meta-analysis. BMC Pulm. Med., 20.","DOI":"10.1186\/s12890-020-01192-w"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.resinv.2021.11.012","article-title":"Bronchoscopy for the diagnosis of nontuberculous mycobacterial pulmonary disease: Specificity and diagnostic yield in a retrospective cohort study","volume":"60","author":"Tomishima","year":"2022","journal-title":"Respir. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1164\/ajrccm.155.6.9196113","article-title":"Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease","volume":"155","author":"Tanaka","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s10156-003-0267-1","article-title":"Usefulness of bronchial lavage for the diagnosis of pulmonary disease caused by Mycobacterium avium-intracellulare complex (MAC) infection","volume":"9","author":"Sugihara","year":"2003","journal-title":"J. Infect. Chemother."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"728","DOI":"10.11150\/kansenshogakuzasshi1970.73.728","article-title":"Usefulness of bronchoscopy for the diagnosis of atypical pulmonary mycobacteriosis","volume":"73","author":"Watanuki","year":"1999","journal-title":"Kansenshogaku Zasshi"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1378\/chest.115.4.1033","article-title":"Mycobacterium avium-intracellulare pulmonary infection in HIV-negative patients without preexisting lung disease: Diagnostic and management limitations","volume":"115","author":"Huang","year":"1999","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1183\/20734735.042912","article-title":"Induced sputum analysis: Step by step","volume":"9","author":"Weiszhar","year":"2013","journal-title":"Breathe Jun."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Stanzel, F. (2012). Bronchoalveolar Lavage. Principles and Practice of Interventional Pulmonology, Springer.","DOI":"10.1007\/978-1-4614-4292-9_16"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.chest.2018.01.024","article-title":"Microbiologic Outcome of Interventions Against Mycobacterium avium Complex Pulmonary Disease: A Systematic Review","volume":"153","author":"Diel","year":"2018","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s15010-024-02183-3","article-title":"Drugs for treating infections caused by non-tubercular mycobacteria: A narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine","volume":"52","author":"Calcagno","year":"2024","journal-title":"Infection"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2739\/kurumemedj.48.15","article-title":"The significance of bronchoscopy for the diagnosis of Mycobacterium avium complex (MAC) pulmonary disease","volume":"48","author":"Ikedo","year":"2001","journal-title":"Kurume Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1902196","DOI":"10.1183\/13993003.02196-2019","article-title":"Serial sputum induction in nontuberculous mycobacterial pulmonary disease","volume":"55","author":"Holt","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1183\/09031936.93.03080937","article-title":"Clinical guidelines and indications for bronchoalveolar lavage (BAL): Report of the European Society of Pneumology Task Group on BAL","volume":"3","author":"Klech","year":"1990","journal-title":"Eur. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4103\/2229-5151.164995","article-title":"Complications of bronchoscopy: A concise synopsis","volume":"5","author":"Stahl","year":"2015","journal-title":"Int. J. Crit. Illn. Inj. Sci."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/12\/1064\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:45:44Z","timestamp":1760114744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/12\/1064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,3]]},"references-count":22,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["pathogens13121064"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13121064","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,3]]}}}