Changes in sputum composition during 15min of sputum induction in healthy subjects and patients with asthma and chronic obstructive pulmonary disease

SummaryIntroductionThe use of sputum induction by inhalation of hypertonic saline to study the cellular and biochemical composition of the airways allows noninvasive sampling of the airways content and identification of markers of airways inflammation.ObjectiveThe present study aimed to identify possible changes in the cellular composition of induced sputum between samples obtained sequentially (three periods of 5min each) during one sputum induction. Moreover, difference between these samples and the mixed one (mixture of samples obtained after 5, 10 and 15min of induction) was investigated.MethodsForty-six subjects (10 healthy volunteers, 12 patients with chronic obstructive pulmonary disease (COPD) and 24 patients with asthma) (mean age 53.0±14.0yr, forced expiratory volume in one second (FEV1) 71.8±19.0% pred) produced sputum after three consecutive 5min periods of hypertonic (4.5%) saline inhalation. Stained cytospins from the three periods separately and from the mixed sample were produced and analyzed.ResultsThe mean percentage of neutrophils, eosinophils, lymphocytes and epithelial cells did not change significantly in samples obtained consecutively after 5, 10 and 15min of the induction procedure. There was no significant difference in the cellular composition of samples obtained after 5, 10 and 15min of induction and the cellular composition of the mixed sample (P=0.06).ConclusionThe separate analysis of induced sputum from three consecutive sampling and the mixed sample did not demonstrate significant changes in their cellular composition. Fifteen minutes induction procedure with the fixed concentration of hypertonic saline and processing of the mixed sample can be recommended for clinical settings and clinical trials

Determination of risk factors for the development of tuberculosis with drug-resistant strains of Mycobacterium tuberculosis in the Arkhangelsk oblast, Russia

DESIGN: Strains isolated from 119 patients with pulmonary tuberculosis were studied by the BACTEC method. Medical records of the patients were reviewed, retrospectively, to identify factors associated with drug resistance. RESULTS: Sixty-seven strains (56.3%) were resistant to at least one antituberculosis drug. Thirty of the 119 strains (25.2%) were multi-drug resistant. All strains resistant to rifampicin were multi-drug resistant. Multidrug resistance was four times more common among previously treated patients than among new patients. The highest rates of drug resistance were observed for streptomycin and isoniazid. 40.4% and 66.7% of strains collected from new and previously treated patients were resistant to streptomycin, respectively. 37.1% and 73.3% of strains collected from new and previously treated patients were resistant to isoniazid, respectively. A history of previous or interrupted treatment for tuberculosis and being female were significantly associated with resistance to at least one anti-tuberculosis drug and multidrug resistance. CONCLUSION: Drug-resistant tuberculosis is an important problem in the Arkhangelsk oblast, Russia. The spread of drug-resistant strains of M. tuberculosis is attributed to several risk factors. A history of previous or interrupted treatment for tuberculosis and being female are significantly associated with resistance to at least one anti-tuberculosis drug and multidrug resistance. Employment in the health sector of Arkhangelsk was significantly associated with the development of drug resistance

Spread of Drug-Resistant Mycobacterium tuberculosis Strains of the Beijing Genotype in the Archangel Oblast, Russia

A collection of 119 strains of Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis in the Archangel Oblast, Russia, in 1998 and 1999 were studied by using restriction fragment length polymorphism (RFLP) analysis with the IS6110 probe and spoligotyping. Resistance of the strains to antituberculosis drugs was analyzed by the BACTEC method, and mutations associated with rifampin resistance were detected by using the Inno-LiPA Rif. TB test. RFLP analysis and spoligotyping demonstrated that 53 (44.5%) of the strains belonged to the Beijing genotype. These strains showed a significantly higher rate of resistance than M. tuberculosis strains of other genotypes circulating in the region. In particular, 43.4% of the strains of the Beijing genotype were multidrug resistant; in contrast, only 10.6% of the other strains were. Of the strains of the Beijing genotype, 92.5% were part of a cluster, while only 33.3% of the remaining strains were clustered. Analysis of the medical records of the patients demonstrated that individuals infected with a strain of the Beijing genotype were significantly more likely to be alcohol abusers and to have chronic obstructive pulmonary disease prior to the tuberculosis diagnosis. Multivariate analysis showed that both variables were independently associated with infection by strains belonging to the Beijing genotype. Our study demonstrated that strains of the Beijing genotype are an important cause of tuberculosis in the Archangel Oblast and that dissemination of these strains is associated with the high incidence of drug resistance