Experts and Doctors on sputum in Cape Town, Western Cape, South Africa


Locale: Cape Town, Western Cape, South Africa
Topic: sputum

Top Publications

  1. Peter J, Theron G, Muchinga T, Govender U, Dheda K. The diagnostic accuracy of urine-based Xpert MTB/RIF in HIV-infected hospitalized patients who are smear-negative or sputum scarce. PLoS ONE. 2012;7:e39966 pubmed publisher
    ..Concentration of urine prior to MTB/RIF-testing significantly improves sensitivity. ..
  2. Visser M, Stead M, Walzl G, Warren R, Schomaker M, Grewal H, et al. Baseline predictors of sputum culture conversion in pulmonary tuberculosis: importance of cavities, smoking, time to detection and W-Beijing genotype. PLoS ONE. 2012;7:e29588 pubmed publisher
    ..Larger studies are needed to confirm the relationship between the W-Beijing genotype and sputum culture conversion. ..
  3. Theron G, Pooran A, Peter J, van Zyl Smit R, Kumar Mishra H, Meldau R, et al. Do adjunct tuberculosis tests, when combined with Xpert MTB/RIF, improve accuracy and the cost of diagnosis in a resource-poor setting?. Eur Respir J. 2012;40:161-8 pubmed publisher
    ..In MTB/RIF-negative individuals, CXR has poor rule-in value but can reliably rule out TB in approximately one in four cases. These data inform upon the programmatic utility of MTB/RIF in high-burden settings. ..
  4. Dawson R, Condos R, Tse D, Huie M, Ress S, Tseng C, et al. Immunomodulation with recombinant interferon-gamma1b in pulmonary tuberculosis. PLoS ONE. 2009;4:e6984 pubmed publisher NCT00201123. ..
  5. Smith A, Burger R, Claassens M, Ayles H, Godfrey Faussett P, Beyers N. Health care workers' gender bias in testing could contribute to missed tuberculosis among women in South Africa. Int J Tuberc Lung Dis. 2016;20:350-6 pubmed publisher
    ..6% vs. 20.7%, P = 0.023). The attainment of sex equity in the provision of TB health services requires adherence to testing protocols. Everyone, irrespective of sex, who seeks care for a cough of ?2 weeks should be tested. ..
  6. Peter J, Theron G, Dheda K. Can point-of-care urine LAM strip testing for tuberculosis add value to clinical decision making in hospitalised HIV-infected persons?. PLoS ONE. 2013;8:e54875 pubmed publisher
    ..However, compared to empiric treatment, LAM identified a different subset of patients with more advanced immunosuppression and greater disease severity. ..
  7. Nicol M, Workman L, Isaacs W, Munro J, Black F, Eley B, et al. Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study. Lancet Infect Dis. 2011;11:819-24 pubmed publisher
    ..National Institutes of Health, the National Health Laboratory Service Research Trust, the Medical Research Council of South Africa, and Wellcome Trust. ..
  8. Cashmore T, Peter J, van Zyl Smit R, Semple P, Maredza A, Meldau R, et al. Feasibility and diagnostic utility of antigen-specific interferon-gamma responses for rapid immunodiagnosis of tuberculosis using induced sputum. PLoS ONE. 2010;5:e10389 pubmed publisher
    ..However, the test, in its current ELISPOT format, is not clinically useful because the majority of the assays are inconclusive. ..
  9. Barnard M, Warren R, Gey van Pittius N, van Helden P, Bosman M, Streicher E, et al. Genotype MTBDRsl line probe assay shortens time to diagnosis of extensively drug-resistant tuberculosis in a high-throughput diagnostic laboratory. Am J Respir Crit Care Med. 2012;186:1298-305 pubmed publisher
    ..The rapid dissemination of second-line DST results will guide initiation of appropriate treatment, thereby reducing transmission and improving treatment outcome. ..

More Information


  1. Wiseman C, Schaaf H, Cotton M, Gie R, Jennings T, Whitelaw A, et al. Bacteriologically confirmed tuberculosis in HIV-infected infants: disease spectrum and survival. Int J Tuberc Lung Dis. 2011;15:770-5 pubmed publisher
    ..Although the effects of young age, TB disease spectrum and HIV co-infection are difficult to distinguish, our findings support the initiation of early ART in HIV-infected infants with TB. ..
  2. Lawn S, Kerkhoff A, Vogt M, Wood R. High diagnostic yield of tuberculosis from screening urine samples from HIV-infected patients with advanced immunodeficiency using the Xpert MTB/RIF assay. J Acquir Immune Defic Syndr. 2012;60:289-94 pubmed publisher
    ..Urine Xpert testing provides a means of rapid TB diagnosis in patients with advanced immunodeficiency and poor prognosis. These data are indicative of high rates of TB dissemination and renal involvement in this clinical population. ..
  3. Wood R, Racow K, Bekker L, Middelkoop K, Vogt M, Kreiswirth B, et al. Lipoarabinomannan in urine during tuberculosis treatment: association with host and pathogen factors and mycobacteriuria. BMC Infect Dis. 2012;12:47 pubmed publisher
    ..However, the LAM-ELISA assay has demonstrated variable sensitivity in diagnosing TB in diverse clinical populations. We therefore explored pathogen and host factors potentially impacting LAM detection...
  4. Diacon A, Dawson R, von Groote Bidlingmaier F, Symons G, Venter A, Donald P, et al. Randomized dose-ranging study of the 14-day early bactericidal activity of bedaquiline (TMC207) in patients with sputum microscopy smear-positive pulmonary tuberculosis. Antimicrob Agents Chemother. 2013;57:2199-203 pubmed publisher
    ..The finding of a linear trend for dose suggests that the highest dose compatible with safety considerations should be taken forward to longer-term clinical studies. ..
  5. Lawn S, Kerkhoff A, Vogt M, Wood R. HIV-associated tuberculosis: relationship between disease severity and the sensitivity of new sputum-based and urine-based diagnostic assays. BMC Med. 2013;11:231 pubmed publisher
    ..These data provide strong justification for large-scale intervention studies that assess the impact on survival of screening using these new sputum-based and urine-based diagnostic approaches. ..
  6. Pietersen E, Ignatius E, Streicher E, Mastrapa B, Padanilam X, Pooran A, et al. Long-term outcomes of patients with extensively drug-resistant tuberculosis in South Africa: a cohort study. Lancet. 2014;383:1230-9 pubmed publisher
    ..European and Developing Countries Clinical Trials Partnership, South African National Research Foundation (SARChI), and the South African Medical Research Council. ..
  7. Hesseling A, Walzl G, Enarson D, Carroll N, Duncan K, Lukey P, et al. Baseline sputum time to detection predicts month two culture conversion and relapse in non-HIV-infected patients. Int J Tuberc Lung Dis. 2010;14:560-70 pubmed
    ..Baseline TTD and smear grading predicted month 2 culture conversion, relapse and also recurrence. These markers may be useful to identify non-HIV-infected patients at risk of recurrence, and may be relevant in clinical trials. ..
  8. Dheda K, Davids V, Lenders L, Roberts T, Meldau R, Ling D, et al. Clinical utility of a commercial LAM-ELISA assay for TB diagnosis in HIV-infected patients using urine and sputum samples. PLoS ONE. 2010;5:e9848 pubmed publisher
    ..However, even in this group sensitivity was modest. Future and adequately powered studies in a primary care setting should now specifically target patients with suspected TB who have advanced HIV infection. ..
  9. Morrow B, Hsaio N, Zampoli M, Whitelaw A, Zar H. Pneumocystis pneumonia in South African children with and without human immunodeficiency virus infection in the era of highly active antiretroviral therapy. Pediatr Infect Dis J. 2010;29:535-9 pubmed publisher
    ..Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in human immunodeficiency virus (HIV)-infected African children...
  10. Hatherill M, Hawkridge T, Zar H, Whitelaw A, Tameris M, Workman L, et al. Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?. Arch Dis Child. 2009;94:195-201 pubmed publisher
    ..The optimal diagnostic yield may be obtained from paired IS and GL specimens taken on a single day or two GL specimens taken on consecutive days. ..
  11. Botha E, den Boon S, Lawrence K, Reuter H, Verver S, Lombard C, et al. From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa. Int J Tuberc Lung Dis. 2008;12:936-41 pubmed
    ..By correcting diagnostic weaknesses identified in the sputum register, PHC facilities will be able to detect, treat and cure a higher percentage of TB patients. ..
  12. Marais B, Brittle W, Painczyk K, Hesseling A, Beyers N, Wasserman E, et al. Use of light-emitting diode fluorescence microscopy to detect acid-fast bacilli in sputum. Clin Infect Dis. 2008;47:203-7 pubmed publisher
    ..We evaluated the diagnostic performance of fluorescence microscopy, using novel light-emitting diode (LED) technology as an alternative to the conventional mercury vapor lamp (MVP)...
  13. Diacon A, Dawson R, von Groote Bidlingmaier F, Symons G, Venter A, Donald P, et al. 14-day bactericidal activity of PA-824, bedaquiline, pyrazinamide, and moxifloxacin combinations: a randomised trial. Lancet. 2012;380:986-93 pubmed publisher
    ..Multiagent EBA studies can contribute to reducing the time needed to develop new antituberculosis regimens. The Global Alliance for TB Drug Development (TB Alliance). ..
  14. Theron G, Zijenah L, Chanda D, Clowes P, Rachow A, Lesosky M, et al. Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial. Lancet. 2014;383:424-35 pubmed publisher
    ..We aimed to assess the feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing at primary-care health-care facilities in southern Africa...
  15. Claassens M, du Toit E, Dunbar R, Lombard C, Enarson D, Beyers N, et al. Tuberculosis patients in primary care do not start treatment. What role do health system delays play?. Int J Tuberc Lung Dis. 2013;17:603-7 pubmed publisher
    ..Initial loss to follow-up should be reported as part of the TB programme to ensure that patients are initiated on treatment to prevent transmission within communities. ..
  16. Lawn S, Kerkhoff A, Vogt M, Wood R. Diagnostic and prognostic value of serum C-reactive protein for screening for HIV-associated tuberculosis. Int J Tuberc Lung Dis. 2013;17:636-43 pubmed publisher
    ..CRP concentrations identified groups of patients with very high or very low TB risk, but only in an unacceptably small minority of patients screened. However, in those with confirmed TB, CRP concentrations had useful prognostic value. ..
  17. Gina P, Randall P, Muchinga T, Pooran A, Meldau R, Peter J, et al. Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection. BMC Infect Dis. 2017;17:339 pubmed publisher
    ..001). LF-LAM specificity was not determined. This proof of concept study indicates that EMU could improve the sensitivity of LF-LAM in hospitalised TB-HIV co-infected patients. These data have implications for clinical practice. ..
  18. Rockwood N, Wojno J, Ghebrekristos Y, Nicol M, Meintjes G, Wilkinson R. Utility of Second-Generation Line Probe Assay (Hain MTBDRplus) Directly on 2-Month Sputum Specimens for Monitoring Tuberculosis Treatment Response. J Clin Microbiol. 2017;55:1508-1515 pubmed publisher
    ..87; 95% CI, 1.11 to 7.42). There is moderate utility of direct 2-month MTBDRplus to predict culture conversion at 2 months and also to predict an unfavorable outcome. ..
  19. Zampoli M, Zar H. Conservative management of a ruptured pulmonary hydatid cyst. Pediatr Pulmonol. 2007;42:1229-32 pubmed
    ..We report a 7-year-old child who developed rupture of a large pulmonary hydatid cyst following chest trauma; conservative management resulted in successful expulsion of the cyst...
  20. Lawn S, Kerkhoff A, Pahlana P, Vogt M, Wood R. Diagnostic yield of tuberculosis using sputum induction in HIV-positive patients before antiretroviral therapy. Int J Tuberc Lung Dis. 2012;16:1354-7 pubmed publisher
    ..8-18.8). Spontaneously expectorated spot samples yielded 79.8% of all culture-positive TB diagnoses. The incremental yield from those needing an induced first sample was 5.3% and the yield from induced second samples was 14.9%. ..
  21. Wood R, Racow K, Bekker L, Morrow C, Middelkoop K, Mark D, et al. Indoor social networks in a South African township: potential contribution of location to tuberculosis transmission. PLoS ONE. 2012;7:e39246 pubmed publisher
    ..Further studies of the environmental conditions in schools and public transport, as potentially important locations for ongoing TB infection, are indicated. ..
  22. Peter J, Cashmore T, Meldau R, Theron G, van Zyl Smit R, Dheda K. Diagnostic accuracy of induced sputum LAM ELISA for tuberculosis diagnosis in sputum-scarce patients. Int J Tuberc Lung Dis. 2012;16:1108-12 pubmed publisher
  23. Lawn S, Kerkhoff A, Vogt M, Wood R. Clinical significance of lipoarabinomannan detection in urine using a low-cost point-of-care diagnostic assay for HIV-associated tuberculosis. AIDS. 2012;26:1635-43 pubmed publisher
    ..If used in combination with laboratory-based diagnostics, treatment delays would decrease and survival might be improved. ..
  24. Moyo S, Isaacs F, Gelderbloem S, Verver S, Hawkridge A, Hatherill M, et al. Tuberculin skin test and QuantiFERON® assay in young children investigated for tuberculosis in South Africa. Int J Tuberc Lung Dis. 2011;15:1176-81, i pubmed publisher
    ..Our results suggested equivalent performance of QFT and TST in the diagnosis of TB disease in young children in a high-burden setting. ..
  25. Kranzer K, Olson L, van Schaik N, Raditlhalo E, Hudson E, Panigrahi P, et al. Quality of induced sputum using a human-powered nebuliser in a mobile human immunodeficiency virus testing service in South Africa. Int J Tuberc Lung Dis. 2011;15:1077-81 pubmed publisher
    ..Further research needs to investigate the yield of TB in sputum samples induced by the HPN. ..
  26. Diacon A, Dawson R, Hanekom M, Narunsky K, Venter A, Hittel N, et al. Early bactericidal activity of delamanid (OPC-67683) in smear-positive pulmonary tuberculosis patients. Int J Tuberc Lung Dis. 2011;15:949-54 pubmed publisher
    ..Delamanid at all dosages was safe, well tolerated and demonstrated significant exposure-dependent EBA over 14 days, supporting further investigation of its pharmacokinetics and anti-tuberculosis activity. ..
  27. Diacon A, Dawson R, Hanekom M, Narunsky K, Maritz S, Venter A, et al. Early bactericidal activity and pharmacokinetics of PA-824 in smear-positive tuberculosis patients. Antimicrob Agents Chemother. 2010;54:3402-7 pubmed publisher
    ..Because maximum efficacy was unexpectedly achieved at the lowest dosage tested, the activity of lower dosages should now be explored. ..
  28. Dawson R, Masuka P, Edwards D, Bateman E, Bekker L, Wood R, et al. Chest radiograph reading and recording system: evaluation for tuberculosis screening in patients with advanced HIV. Int J Tuberc Lung Dis. 2010;14:52-8 pubmed
    ..The utility of radiology as a screening test for TB in this patient group, however, remains limited. ..
  29. Djoba Siawaya J, Bapela N, Ronacher K, Veenstra H, Kidd M, Gie R, et al. Immune parameters as markers of tuberculosis extent of disease and early prediction of anti-tuberculosis chemotherapy response. J Infect. 2008;56:340-7 pubmed publisher
    ..5% accuracy and the slow responders with up to 83.3% accuracy These preliminary results suggest that predictive models for differential early treatment responses using combinations of host markers hold promise. ..
  30. Schaaf H, Marais B, Whitelaw A, Hesseling A, Eley B, Hussey G, et al. Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases. BMC Infect Dis. 2007;7:140 pubmed
    ..With cavitating disease and sputum or gastric aspirates positive for acid-fast bacilli, children may be infectious. Transmission of drug-resistant TB is high in this setting. ..
  31. Dramowski A, Morsheimer M, Jordaan A, Victor T, Donald P, Schaaf H. Rifampicin-monoresistant Mycobacterium tuberculosis disease among children in Cape Town, South Africa. Int J Tuberc Lung Dis. 2012;16:76-81 pubmed publisher
    ..Delay in commencing appropriate treatment for RMR-TB and high rates of cavitary disease could be a source of RMR-TB transmission. ..
  32. Claassens M, Jacobs E, Cyster E, Jennings K, James A, Dunbar R, et al. Tuberculosis cases missed in primary health care facilities: should we redefine case finding?. Int J Tuberc Lung Dis. 2013;17:608-14 pubmed publisher
    ..Intensified case finding should start within the facility, and should not be limited to patients who report respiratory symptoms or who are human immunodeficiency virus positive. ..