Induced sputum as an adequate clinical specimen for the etiological diagnosis of community-acquired pneumonia (CAP) in children and adolescents

Rueda, Zulma Vanessa; Bermúdez, Marcela; Restrepo, Alberto; Garcés, Carlos; Morales, Olga; Roya-Pabón, Claudia; Carmona, Luisa Fernanda; Arango, Catalina; Albarracín, Jose Luis; López-López, Lucelly; Aguilar, Yudy; Maya, María Angélica; Trujillo, Mónica; Copete, Angela Rocio; Vera, Cristian; Herrera, Mariana; Giraldo, Margarita Rosa; Niño-Cruz, Gloria Isabel; Vélez, Lázaro A.

doi:10.1016/j.ijid.2022.01.026

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…Although sputum induction is generally regarded as safe and successful in both children and adults (63)(64)(65)(66)(67)(68)(69)(70), recommended contraindications that must be taken into account to preclude or delay induced sputum collection are noted (Table 3). After exclusion or resolution of the contraindicated conditions, sputum induction can be considered (71).…”

Section: Discussionmentioning

confidence: 99%

Sputum induction and its diagnostic applications in inflammatory airway disorders: a review

Goncalves,

Eze

2023

Front. Allergy

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Sputum induction is a technique that covers the induction and the subsequent processing of the expectorate primarily for the analysis of cells and different inflammatory biomarkers present in the airways to further understand the pathophysiology of different inflammatory respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD) as well as the diagnosis of lung diseases such as lung cancer, tuberculosis, and Pneumocystis jirovecii pneumonia. It is a non-invasive, safe, cost-effective, and reliable technique reported to exhibit a high success rate. However, due to being technically demanding and time-consuming and having the need of employing trained staff, this technique is only used in restricted research centres and in limited centres of clinical use. When the sputum is collected after induction, the primary goal is to obtain a differential cell count and evaluate the molecular biomarkers of airway inflammation such as eosinophil cationic protein, eosinophil-derived neurotoxin, major basic protein, tryptase, cytokine production [e.g., interleukin (IL)-5], albumin, and fibrinogen. In addition, cytospins from the processed sputum are used for immunocytochemical staining of cellular products such as EG-2 reactive protein, granulocyte-macrophage colony-stimulating factor, tumour necrosis factor alpha, and IL-8 that play significant roles in understanding the pathophysiology of inflammatory airway diseases. Nowadays, this technique can be further used by performing an additional analysis such as flow cytometry and in situ hybridisation on the sputum supernatant to investigate more the immune response and pathophysiological process of such various respiratory diseases. In addition, the application of sputum fluid phase to assess the biomarkers could be used more routinely in pathological laboratories for diagnosing lung cancer, COPD, and asthma as well as for monitoring lung cancer progression and asthma and COPD treatment, allowing for early detection and a better treatment provided by the clinicians.

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Section: Discussionmentioning

confidence: 99%

Sputum induction and its diagnostic applications in inflammatory airway disorders: a review

Goncalves,

Eze

2023

Front. Allergy

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“…Obtaining a representative sample from the lower respiratory tract can be difficult in non-intubated patients and contamination with organisms that colonize the upper respiratory tract (or a tracheostomy) is common [ 51 ]. The collection of specimens from the lower respiratory tract—for example, by obtaining induced sputum—could improve the diagnostic value of the findings in pediatric patients with bacterial LRTIs, but may not be feasible in patients with an SNI [ 52 ]. Bronchoscopy with bronchoalveolar lavage may provide a representative sample from the lower respiratory tract, but is not always warranted or possible in the context of the palliative nature of the disease or its complexity.…”

Section: Discussionmentioning

confidence: 99%

Lower Respiratory Tract Infections in Pediatric Patients with Severe Neurological Impairments: Clinical Observations and Perspectives in a Palliative Care Unit

et al. 2022

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Pediatric palliative care (PPC) patients with a severe neurologic impairment (SNI) suffer considerable morbidity and increased mortality from lower respiratory tract infections (LRTIs). The indication and choice of antibiotic therapy for bacterial LRTIs are often challenging given the lack of evidence-based treatment recommendations for this vulnerable patient population. We conducted an observational study before the SARS-CoV-2 pandemic in an eight-bed pediatric palliative care inpatient unit. During two years of surveillance, we diagnosed and treated 33 cases of a bacterial LRTI in patients with an SNI; 5 patients were hospitalized with an LRTI more than once. Two patients died from complications due to LRTIs during hospitalization. Three patients (15%) were colonized with multidrug-resistant organisms. An initial antibiotic treatment failed in one-third of the cases; a successful therapy of the LRTI was achieved with broad-spectrum and extended-spectrum penicillins (n = 13; in combination with β-lactamase inhibitors for n = 5 cases), cephalosporins (n = 13: n = 4 second-generation and n = 9 third-generation cephalosporins; in combination with other substances for n = 5 cases), ciprofloxacin (n = 3), and meropenem plus vancomycin (n = 2) or meropenem (n = 1). A respiratory specimen was obtained in 66.7% of cases with P. aeruginosa, E. coli, and K. pneumoniae accounting for the majority of the detected species. In most cases, there was no definite confirmation that the LRTI was caused by the species detected. The diagnostics and treatment of bacterial LRTIs in PPC patients with an SNI are challenging. The lack of controlled studies and the heterogeneity of this population often necessitate an individual approach. This lack of controlled studies may partly be compensated by a set of diagnostic and antibiotic stewardship criteria.

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“…The feasibility for patients with severe airflow obstruction to expel phlegm is low, so conversely, an induced sputum sample is required with the aid of an ultrasonic wave nebulizer [34]. A specimen is taken after hypertonic saline in concentrations of 0.9% -7% is inhaled for 15-30 minutes [35,36]; this helps the production of phlegm in children who cannot and is an ideal procedure to diagnose airway illnesses [37][38][39]. To prevent bronchoconstriction that would be induced by hypertonic saline inhalation, it is recommended to inhale salbutamol before sampling [40,41].…”

Section: Methods and Systems Utilized To Study Sputum Proteomicsmentioning

confidence: 99%

Human Sputum Proteomics: Advancing Non-Invasive Diagnosis of Respiratory Diseases with Enhanced Biomarker Analysis Methods

Guzman,

Guzman

2024

Preprint

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Many ailments can be diagnosed while they are asymptomatic, meaning that the patient has no signs or symptoms of a progressing disease. If caught in their initial stage of formation, these maladies can be effectively treated, leading to successful outcomes; curative therapies can halt illnesses from advancing, thus improving the quality of life, and long-term survival of the patient. Still cutting-edge upgrades in precision technologies are necessary for early, reliable, affordable, and rapid disease detection, but also are vital for the well-being of people and the future of global public health. The emerging role and utility of non-invasive and repeatable diagnostic test approaches for detection of health conditions has been liquid biopsies based on genomic biomarkers. As such, biological fluids permit any measurable molecular indicator or signature (e.g., proteins), to provide valuable information on individual’s wellness and/or disease. Among the bodily secretions used for non-invasive diagnostics is sputum, a complex viscous gel-like biopolymeric network, that has gained growing recognition as a rich source of biomarkers of airway infections, pulmonary diseases, and serves as a determinant to reveal other illnesses. As per the World Health Organization, the burden of respiratory conditions is exacerbated by factors, ranging from considerable subjection to air pollution and occupational contaminants, to tobacco smoking and second-hand smoke, in addition to poor socio-economic status. Due to the likely increase of these determinants, respiratory tract ailments are on the rise, affecting the health of many individuals, in addition to putting stress on healthcare facilities and services worldwide. We therefore highlight the need to use expectorated or induced sputum specimens as a routine sample source for testing valuable protein biomarkers to diagnose these chronic maladies, to predict inflammation and disease progression, as well as monitor the effectiveness of treatments. Further, we discuss the urgency for fast and reliable point-of-care methods to detect and quantify crucial protein biomarkers in sputum specimens, and limitations faced when dealing with their complex matrices.

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Induced sputum as an adequate clinical specimen for the etiological diagnosis of community-acquired pneumonia (CAP) in children and adolescents

Abstract: Induced sputum as an adequate clinical specimen for the etiological diagnosis of community-acquired pneumonia (CAP) in children and adolescents,

Cited by 6 publications

References 32 publications

Sputum induction and its diagnostic applications in inflammatory airway disorders: a review

Sputum induction and its diagnostic applications in inflammatory airway disorders: a review

Lower Respiratory Tract Infections in Pediatric Patients with Severe Neurological Impairments: Clinical Observations and Perspectives in a Palliative Care Unit

Human Sputum Proteomics: Advancing Non-Invasive Diagnosis of Respiratory Diseases with Enhanced Biomarker Analysis Methods

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