• V Souza Pinto and R H Bammann.
• Task Force of National Tuberculosis Control Programme for Sao Paulo State, Ministry of Health, Sao Paulo, Brazil; Emilio Ribas Institute for Infectious Diseases, Sao Paulo, Sao Paulo, Brazil. valdirpinto@uol.com.br
• Int. J. Tuberc. Lung Dis. 2007 Dec 1;11(12):1302-7.

SettingA public referral hospital in Sao Paulo, Brazil.ObjectiveTo evaluate chest physiotherapy as a means of obtaining sputum samples from human immunodeficiency virus (HIV) positive in-patients suspected of having pulmonary tuberculosis (TB).DesignA prospective study.Material And MethodsFive consecutive samples were collected from 132 patients using the 'spontaneous' technique (ST) on day 1, slow expiration with the glottis open in a lateral posture ('expiration lente totale glotte ouverte en infralatéral', ELTGOL) on day 2, ST on day 3, sputum induction with hypertonic saline (SIHS) on day 4 and ST on day 5. Samples were processed for acid-fast bacilli (AFB) smear and seeded onto Löwenstein-Jensen medium.ResultsMycobacteria were recovered from 34 patients (25.8%). Nine (26.5%) of the strains were identified as mycobacteria other than Mycobacterium tuberculosis. AFB smear sensitivity was higher in ELTGOL samples than in ST or SIHS samples (52.9% vs. 32.4% and 29.4%), although the difference among the three was not significant (P = 0.098). In culture, the three ST samples proved significantly more sensitive (P = 0.05).ConclusionsPhysiotherapy shows promise as a technique for obtaining sputum from HIV-positive patients, and AFB testing of a single sample presents high sensitivity. However, this does not preclude the routine collection of three samples, as TB cannot be ruled out before the culture results are known.

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