Induced Sputum Versus Bronchoscopy in Smear Negative Pulmonary Tuberculosis
Induced Sputum Versus Bronchoscopy in Smear Negative Pulmonary Tuberculosis
This is a randomised study that compares different diagnostic approaches for diagnosing
 pulmonary tuberculosis in patients suspected of pulmonary tuberculosis in whom the three
 classic (non-induced) sputum samples didn't show tuberculous bacillus on direct examination.

 The investigators compare the sensibility of induced sputum technique with an endoscopic
 approach (CT-scan followed by BAL and fluoroscopy-guided transbronchial biopsies and
 eventually sputum collection immediately after the bronchoscopy).

 People in high risk population for tuberculosis undergoing screening by chest X-ray or
 symptomatic patients will be admitted to the hospital if their chest X-ray shows a suspicion
 of active tuberculosis.

 According good clinical practice: (non-induced) sputum samples will be taken at admission and
 every following morning. If direct examination and PCR of the first three classic sputum
 samples are negative: patients will be randomised in two groups with a different diagnostic
 approach (induced sputum versus endoscopic approach) The aim of our study is to proof that a
 thoroughgoing endoscopic approach has a higher sensibility than an induced sputum in the
 diagnosis of pulmonary tuberculosis in patients with a high suspicion of active tuberculosis
 on the chest X-ray but with a negative direct examination and/or PCR on three consecutive
 normal sputum samples.

 The investigators will include 154 patients (based on a statistical analysis for a hypothesis
 that the endoscopic approach has a sensibility that's twice the sensibility of the induced
 sputum).

 -  first arm: 2 consecutive induced sputum using an ultrasonic nebulizer.

 -  second arm: CT thorax to evaluate the exact anatomic localisation of the disease
 followed by fluoroscopy-guided bronchoscopy for BAL (bronchoalveolar lavage) and
 transbronchial biopsies. A sputum sample immediately after the endoscopy will be
 collected if possible.
Inclusion Criteria:

 -  Patient suspected of pulmonary tuberculosis with 3 consecutive (non-induced) sputum
 samples negative on direct exam and PCR.

 Exclusion Criteria:

 -  Age < 18

 -  Pregnancy

 -  Actual asthma exacerbation

 -  Participation to study refused by patient