Calidad de la muestra de esputo y rendimiento diagnóstico de tuberculosis pulmonar: implicaciones para la práctica de enfermería. Revisión sistemática

Ingrid Valeria Flores Zambrano; Katherin Dayana Illusanguil Corro

Authors

Ingrid Valeria Flores Zambrano PUCETEC - Universidad católica Ambato. Ambato, Ecuador Author https://orcid.org/0000-0002-7079-5625
Katherin Dayana Illusanguil Corro Hospital General Puyo, Ecuador Author https://orcid.org/0009-0000-0337-3396

Keywords:

Tuberculosis, Esputo, Técnicas y procedimientos diagnósticos, Sensibilidad y especificidad, Enfermería

Abstract

Introducción: La calidad de la muestra de esputo es un factor crítico en el diagnóstico de la tuberculosis, ya que influye directamente en la sensibilidad y precisión de las pruebas microbiológicas y moleculares. Sin embargo, su impacto en el rendimiento diagnóstico continúa siendo subestimado en la práctica clínica. Objetivo: Analizar la influencia de la calidad de la muestra de esputo en el rendimiento diagnóstico de la tuberculosis y sus implicaciones para la práctica de enfermería. Metodología: Se realizó una revisión sistemática siguiendo las directrices PRISMA 2020. La búsqueda se llevó a cabo en PubMed, Scopus, Web of Science y Scielo, identificándose 230 registros iniciales. Tras la eliminación de duplicados y la aplicación de criterios de inclusión y exclusión, se seleccionaron 15 estudios para el análisis cualitativo. Resultados: Los estudios evidenciaron que variables como el volumen, la consistencia y la técnica de recolección del esputo influyen significativamente en la detección de Mycobacterium tuberculosis. La calidad de la muestra impacta directamente en el rendimiento de pruebas como baciloscopía y Xpert MTB/RIF. Asimismo, estrategias como la inducción de esputo y la supervisión del proceso mejoran la calidad de la muestra y la precisión diagnóstica. Conclusiones: La calidad del esputo es determinante en el diagnóstico de la tuberculosis. El personal de enfermería desempeña un rol fundamental en la optimización de la recolección de muestras, contribuyendo a mejorar la detección temprana y el control de la enfermedad.

Downloads

Download data is not yet available.

References

1. Li K, Hu Q, Liu J, Liu S, He Y. Effects of sputum bacillary load and age on GeneXpert and traditional methods in pulmonary tuberculosis: a 4-year retrospective comparative study. BMC Infectious Diseases [Internet]. 2023 Nov 27;23(1):831. Available from: https://link.springer.com/article/10.1186/s12879-023-08832-6

2. Aung YW, Faksri K, Sangka A, Tomanakan K, Namwat W. Detection of Mycobacterium tuberculosis Complex in Sputum Samples Using Droplet Digital PCR Targeting mpt64. Pathogens [Internet]. 2023 Feb 18;12(2):345. Available from: https://www.mdpi.com/2076-0817/12/2/345

3. Cheng X, Chen L, Wan W, Peng J, Wu L, Xin J, et al. Comparison of 3 diagnostic methods for pulmonary tuberculosis in suspected patients with negative sputum smear or no sputum. Medicine [Internet]. 2024 Feb 9;103(6):e37039. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10860950/

4. Kim YW, Kwon BS, Lim SY, Lee YJ, Cho Y j., Yoon HI, et al. Diagnostic value of bronchoalveolar lavage and bronchial washing in sputum-scarce or smear-negative cases with suspected pulmonary tuberculosis: a randomized study. Clinical Microbiology and Infection [Internet]. 2019 Nov 20;26(7):911–6. Available from: https://www.clinicalmicrobiologyandinfection.org/article/S1198-743X(19)30612-3/fulltext

5. Casela M, Cerqueira SMA, De Oliveira Casela T, Pereira MA, Santos SQD, Del Pozo FA, et al. Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital. Jornal Brasileiro De Pneumologia [Internet]. 2018 Apr 1;44(2):112–7. Available from: https://pubmed.ncbi.nlm.nih.gov/29791546/

6. Diktanas S, Vasiliauskiene E, Polubenko K, Danila E, Celedinaite I, Boreikaite E, et al. Factors Associated with Persistent Sputum Positivity at the End of the Second Month of Tuberculosis Treatment in Lithuania. Tuberculosis & Respiratory Diseases [Internet]. 2018 Jan 1;81(3):233. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6030656/

7. Malacarne J, Heirich AS, Cunha EAT, Kolte IV, Souza-Santos R, Basta PC. Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing. Jornal Brasileiro De Pneumologia [Internet]. 2019 Jan 1;45(2):e20180185. Available from: https://www.scielo.br/j/jbpneu/a/5QRqt6KWWkpp9JqhTFtJXxM/?format=html&lang=en

8. Da Silva TM, Soares VM, Ramos MG, Santos AD. Accuracy of a rapid molecular test for tuberculosis in sputum samples, bronchoalveolar lavage fluid, and tracheal aspirate obtained from patients with suspected pulmonary tuberculosis at a tertiary referral hospital. Jornal Brasileiro De Pneumologia [Internet]. 2019 Jan 1;45(2):e20170451. Available from: https://www.scielo.br/j/jbpneu/a/K8pfhBY9gMRmKG3Qzz6Hwpj/abstract/?lang=en

9. Urrútia G, Bonfill X. Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis. Medicina Clínica [Internet]. 2010 Mar 8;135(11):507–11. Available from: https://www.elsevier.es/es-revista-medicina-clinica-2-articulo-declaracion-prismauna-propuesta-mejorar-S0025775310001454

10. Aparna M, S A, I S, D R. Assessment of Sputum Quality and Its Importance in the Rapid Diagnosis of Pulmonary Tuberculosis. Archives Of Clinical Microbiology [Internet]. 17 de agosto de 2016;08(04). Disponible en: https://doi.org/10.4172/1989-8436.100053

11. Da Silva RM, Bazzo ML, Chagas M. Quality of sputum in the performance of polymerase chain reaction for diagnosis of pulmonary tuberculosis. The Brazilian Journal of Infectious Diseases [Internet]. 2010 Jan 1;14(1):116–20. Available from: https://www.bjid.org.br/en-quality-sputum-in-performance-polymerase-articulo-S1413867010700222

12. Lee YJ, Shin S, Roh EY, Yoon JH, Kim DK, Chung HS, et al. Acceptability of sputum specimens for diagnosing pulmonary tuberculosis. Journal of Korean Medical Science [Internet]. 2015 Jan 1;30(6):733. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4444473/

13. Zimba O, Tamuhla T, Basotli J, Letsibogo G, Pals S, Mathebula U, et al. The effect of sputum quality and volume on the yield of bacteriologically-confirmed TB by Xpert MTB/RIF and smear. Pan African Medical Journal [Internet]. 2019 Jan 1;33:110. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6711687/

14. Chandra Tj. Impact of sputum volume in the diagnosis of smear-positive pulmonary tuberculosis. International Journal of Applied and Basic Medical Research [Internet]. 2019 Jan 1;9(2):73. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6477958/

15. Regati M, Srikanth E, Gowrinath K. Study of quality of sputum being submitted for smear examination. The Journal of Clinical and Scientific Research [Internet]. 2021 Jul 1;10(3):145–50. Available from: https://journals.lww.com/jcsr/fulltext/2021/10030/study_of_quality_of_sputum_being_submitted_for.4.aspx

16. Orina F, Mwangi M, Meme H, Kitole B, Amukoye E. Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients. PLoS ONE [Internet]. 2019 Dec 27;14(12):e0227107. Available from: https://pubmed.ncbi.nlm.nih.gov/31881063/

17. Sinshaw W, Kebede A, Bitew A, Tadesse M, Mehamed Z, Alemu A, et al. Effect of sputum quality and role of Xpert® MTB/RIF assay for detection of smear-negative pulmonary tuberculosis in same-day diagnosis strategy in Addis Ababa, Ethiopia [Internet]. Sinshaw | African Journal of Laboratory Medicine. 2022. Available from: https://ajlmonline.org/index.php/ajlm/article/view/1671/2381

18. Da Silva BO, Salindri AD, Gonçalves TO, Cunha EAT, Da Silva Santos A, Santos PCPD, et al. The impact of sputum quality on Xpert positivity in active case-finding for TB. The International Journal of Tuberculosis and Lung Disease [Internet]. 2024 Jan 1;28(1):29–36. Available from: https://pubmed.ncbi.nlm.nih.gov/38178289/

19. Papadopoulou P, Gaeddert M, Gupta-Wright A, Denkinger CM, Marx FM. Sputum availability and quality in country-level TB prevalence surveys. IJTLD OPEN [Internet]. 2024 Nov 1;1(11):528–30. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11558791/

20. Ani-Ugwu NK, Ugwu AO, Ohagwu IC, Omisakin SI, Harrison NE, Anas RF, et al. Comparative Analysis of the Diagnostic Role of Induced Sputum Versus Expectorated Sputum in Patients with Presumptive Diagnosis of Tuberculosis. Academic Medicine & Surgery [Internet]. 2025 May 7; Available from: https://academic-med-surg.scholasticahq.com/article/137699-comparative-analysis-of-the-diagnostic-role-of-induced-sputum-versus-expectorated-sputum-in-patients-with-presumptive-diagnosis-of-tuberculosis

21. Datta S, Shah L, Gilman RH, Evans CA. Comparison of sputum collection methods for tuberculosis diagnosis: a systematic review and pairwise and network meta-analysis. The Lancet Global Health [Internet]. 2017 Jun 16;5(8):e760–71. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30201-2/fulltext

22. Murphy ME, Phillips PPJ, Mendel CM, Bongard E, Bateson ALC, Hunt R, et al. Spot sputum samples are at least as good as early morning samples for identifying Mycobacterium tuberculosis. BMC Medicine [Internet]. 2017 Oct 26;15(1):192. Available from: https://link.springer.com/article/10.1186/s12916-017-0947-9

23. Ugarte-Gil C, Elkington PT, Gotuzzo E, Friedland JS, Moore D a. J. Induced Sputum is Safe and Well-Tolerated for TB Diagnosis in a Resource-Poor Primary Healthcare Setting. American Journal of Tropical Medicine and Hygiene [Internet]. 2014 Dec 23;92(3):633–5. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4350564/

24. Hernandez S, Leyva-Londoño C. La inducción de esputo. El arma olvidada en el diagnóstico de la tuberculosis pulmonar. Archivos De Medicina (Manizales) [Internet]. 2023 Sep 4;23(1). Available from: https://revistasum.umanizales.edu.co/index.php/archivosmedicina/article/view/4846

25. Asemahagn MA, Amsalu G. Determinants of Sputum Smear Positivity among Tuberculosis Suspected Patients in Bahir Dar City, Northwest Ethiopia [Internet]. Available from: https://www.amhsr.org/articles/determinants-of-sputum-smear-positivity-among-tuberculosis-suspected-patients-in-bahir-dar-city-northwest-ethiopia-4296.html

26. Castro ATE, Mendes M, Freitas S, Roxo PC. Diagnostic yield of sputum microbiological analysis in the diagnosis of pulmonary tuberculosis in a period of 10 years. Revista Portuguesa De Pneumologia [Internet]. 2015 Feb 25;21(4):185–91. Available from: https://www.journalpulmonology.org/en-diagnostic-yield-sputum-microbiological-analysis-articulo-X0873215915339460

27. Fefar DR, Thakkar KM, Shah KS, Panjwani DM, KIkani KM, Bhandari SR. Bacterial profile and antibiogram of isolates from sputum samples of suspected pulmonary tuberculosis patients at a tertiary care teaching hospital. IP Indian Journal of Immunology and Respiratory Medicine [Internet]. 2026 Feb 25;11(1):39–45. Available from: https://ijirm.org/archive/volume/11/issue/1/article/26276

28. Kassa GM, Merid MW, Muluneh AG, Fentie DT. Sputum smear grading and associated factors among bacteriologically confirmed pulmonary drug-resistant tuberculosis patients in Ethiopia. BMC Infectious Diseases [Internet]. 2021 Mar 5;21(1):238. Available from: https://link.springer.com/article/10.1186/s12879-021-05933-y

29. Kiflie A, Tufa GT, Salau AO. Sputum smears quality inspection using an ensemble feature extraction approach. Frontiers in Public Health [Internet]. 2023 Jan 25;10:1032467. Available from: https://europepmc.org/article/pmc/pmc9905811

30. Regmi RS, Khadka S, Sapkota S, Adhikari S, Dhakal KK, Dhakal B, et al. Bacterial etiology of sputum from tuberculosis suspected patients and antibiogram of the isolates. BMC Research Notes [Internet]. 2020 Nov 10;13(1):520. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7654065/

31. Rosales-Rimache J, Nunayalle-Vargas M, Rueda-Torres L, Inolopú-Cucche J. Performance of bleach method sputum smear microscopy for the diagnosis of tuberculosis in a highly endemic district in Lima, Peru. International Journal of Environmental Research and Public Health [Internet]. 2022 Dec 22;20(1):135. Available from: https://www.mdpi.com/1660-4601/20/1/135

32. Sari EP, Lutpiatina L, Insana A. The value of the TB IGG/IGM rapid test and erythrocyte sedimentation rate in relation to Xpert MTB/RIF tests in the diagnosis of pulmonary tuberculosis [Internet]. 2026. Available from: https://tropicalhealthandmedicalresearch.com/index.php/JAK/article/view/149

33. Savage HR, Rickman HM, Burke RM, Odland ML, Savio M, Ringwald B, et al. Accuracy of upper respiratory tract samples to diagnose Mycobacterium tuberculosis: a systematic review and meta-analysis. The Lancet Microbe [Internet]. 2023 Sep 12;4(10):e811–21. Available from: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00190-8/fulltext

34. Urabe N, Sakamoto S, Masuoka M, Kato C, Yamaguchi A, Tokita N, et al. Efficacy of three sputum specimens for the diagnosis of Mycobacterium avium complex pulmonary disease. BMC Pulmonary Medicine [Internet]. 2023 Jan 19;23(1):29. Available from: https://link.springer.com/article/10.1186/s12890-023-02327-5

35. Zhao X, Cui K, Bai L, Xu S, Liu W, Shang J, et al. Diagnostic value of SAT-TB in smear-negative pulmonary tuberculosis: A diagnostic accuracy study. Medicine [Internet]. 2024 Dec 13;103(50):e40907. Available from: https://journals.lww.com/md-journal/fulltext/2024/12130/diagnostic_value_of_sat_tb_in_smear_negative.33.aspx

36. Jiang C, Luo X. Self-management and sputum conversion in pulmonary tuberculosis: a prospective study. BMC Infectious Diseases [Internet]. 2026 Feb 2;26(1). Available from: https://link.springer.com/article/10.1186/s12879-026-12558-6

37. Imtiaz S, Batubara EM. Diagnostic value of bronchoscopy in sputum-negative pulmonary tuberculosis patients and its correlation with clinicoradiological features. Annals of Thoracic Medicine [Internet]. 2022 Apr 1;17(2):124–31. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9150657/

38. Ruperti-Macias GE, Cañarte-Vélez JC. Baciloscopias para el diagnóstico de Tuberculosis Pulmonar en pacientes atendidos en el Laboratorio Clínico de Loreto, 2022. Revista Científica De Salud BIOSANA [Internet]. 2024 Mar 31;4(1):201–14. Available from: http://soeici.org/index.php/biosana/article/view/120