[Safety of sputum induction in interstitial lung disease]

INTRODUCTION

Sputum induction (SI) is a safe and effective technique to study airway inflammation in asthma and chronic obstructive pulmonary disease (COPD). However, it has the potential to induce bronchospasm and fall in arterial oxygen saturation (SaO2) in some patients and the safety of the method in interstitial lung disease (ILD) has not been determined. The aim of this study was to examine the effect of SI procedure on spirometric results and SaO2 in patients with ILD.

MATERIAL AND METHODS

We studied prospectively 59 patients (33 males, 26 females) with different ILD (36 - sarcoidosis, 16 - hypersensitivity pneumonitis, 7 - idiopathic pulmonary fibrosis). Sputum was induced by 4 sequential 5-minute inhalations of 5% saline solution and FEV(1), FVC and SaO2 were measured at 5, 10, 15 and 20 minutes of induction.

RESULTS

The procedure was well tolerated, and none of the patients experienced excessive bronchoconstriction, defined as a fall in FEV1 of > or = 20%. Nine patients (15%) had a fall in FEV1 of > or = 10% from the baseline; a drop in FVC of > or = 10% from the baseline was observed in 10 subjects. The mean (SD) maximum per cent fall in FEV1 was 6,3 +/- 4,4%, and in FVC - 6,4 +/- +/- 4,6%. The maximum per cent fall in FEV1 did not correlate with baseline FEV1% predicted (r = -0,099). SaO2 was measured in 42 patients. There was a very small fall in SaO2 at 5, 10, 15 and 20 minutes of induction, although statistically significant (baseline SaO2 = 96,7 +/- 1,9% vs 95,8 +/- 2,4%, p = 0,002; vs 96,1 +/- 2,2%, p = 0,0114; vs 95,7 +/- 2,4%, p = 0,0016; vs 95,9 +/- 2,0%; p = 0,0038, respectively). No significant relationship was found between fall in FEV1, FVC or SaO2 after induction and diagnosis or smoking history.

CONCLUSION

Sputum induction is safe and well tolerated in patients with ILD.

Safety of Sputum Induction in Interstitial Lung Disease

Introduction: Sputum induction (SI) is a safe and effective technique to study airway inflammation in asthma and chronic obstructive pulmonary disease (COPD). However, it has the potential to induce bronchospasm and fall in arterial oxygen saturation (SaO2) in some patients and the safety of the method in interstitial lung disease (ILD) has not been determined. The aim of this study was to examine the effect of SI procedure on spirometric results and SaO2 in patients with ILD. Materials and methods: We studied prospectively 59 patients (33 males, 26 females) with different ILD (36—sarcoidosis, 16—hypersensitivity pneumonitis, 7—idiopathic pulmonary fibrosis). Sputum was induced by 4 sequential 5 min inhalations of 5% saline solution and FEV1, FVC and SaO2 were measured at 5, 10, 15 and 20 minutes of induction. Results: The procedure was well tolerated, and none of the patients experienced excessive bronchoconstriction, defined as a fall in FEV1 of ≥20%. Nine patients (15%) had a fall in FEV1 of ≥10% from the baseline; a drop in FVC of ≥10% from the baseline was observed in 10 subjects. The mean (SD) maximum per cent fall in FEV1 was 6.3 ± 4.4%, and in FVC—6.4 ± 4.6%. The maximum per cent fall in FEV1 did not correlate with baseline FEV1% predicted (r = −0.099). SaO2 was measured in 42 patients. There was a very small fall in SaO2 at 5, 10, 15 and 20 min of induction, although statistically significant (baseline SaO2 = 96.7 ± 1.9% vs. 95.8 ± 2.4%, p = 0.002; vs. 96.1 ± 2.2%, p = 0.0114; vs. 95.7 ± 2.4%, p = 0.0016; vs. 95.9 ± 2.0%; p = 0.0038, respectively). No significant relationship was found between fall in FEV1, FVC or SaO2 after induction and diagnosis or smoking history. Conclusions: Sputum induction is safe and well tolerated in patients with ILD.

Humoral Immune Response against Mycobacterial Antigens in Patients with Tuberculosis and Mycobacterial Infections Other than Tuberculosis

The aim of the study was to compare humoral immune response against various mycobacterial anti­gens in TB and MOTT vs. healthy control group. 350 serum samples from TB patients, 20 samples from MOTT pa­tients and 58 samples from healthy donors were examined. ELISA detecting IgG, lgA and IgM against antigens: 38 kDa and 16 kDa, 38 kDa and lipoarabinomannan, and A-60 were used. Mean IgG level was higher in TB compared to healthy controls (p < 0.001). Mean IgG level against 38kDa and 38 + 16 kDa mycobacterial antigens was higher in TB than in MOTT group. Mean level of the IgG, IgA and IgM antibodies against LAM was higher in MOTT compared to TB patients. In all subgroups person-to-person heterogeneity of antigen recognition was observed. Humoral immune response to recombinant mycobacterial antigens significantly differs in TB and MOTT patients.

[Humoral immune response against mycobacterial antigens in patients with tuberculosis and mycobacterial infections other than tuberculosis]

The aim of the study was to compare humoral immune response against various mycobacterial antigens in TB and MOTT vs healthy control group. 350 serum samples from TB patients, 20 samples from MOTT patients and 58 samples from healthy donors were examined. ELISA detecting IgG, IgA and IgM against antigens: 38 kDa and 16 kDa, 38kDa and lipoarabinomannan, and A-60 were used. Mean IgG level was higher in TB compared to healthy controls (p<0,001). Mean IgG level against 38kDa and 38 + 16 kDa mycobacterial antigens was higher in TB than in MOTT group. Mean level of the IgG, IgA and IgM antibodies against LAM was higher in MOTT compared to TB patients. In all subgroups person-to-person heterogeneity of antigen recognition was observed. Humoral immune response to recombinant mycobacterial antigens significantly differs in TB and MOTT patients.

Humoral immune response against mycobacterial antigens in bronchoalveolar fluid from tuberculosis patients

Resistance to tuberculosis (TB) is cell-mediated but a humoral response is common and may be correlated with the lack of effective local cellular defense mechanisms. The goal of the study was to evaluate IgG, IgA, and IgM-mediated humoral immune response against 38-kDa+16-kDa and 38-kDa+lipoarabinomannan (LAM) mycobacterial antigens in bronchoalveolar fluid (BALF) from patients with pulmonary TB. Non-tuberculosis (NTB) patients were used as control. 179 BALF samples (56 TB and 123 NTB) were examined. Commercially available ELISA-based assays against proteins 38-kDa and 16-kDa or 38-kDa plus LAM were used. Three different dilutions of BALF: 1:1; 1:10, and 1:50 (100) were tested. Only the results obtained with the 1:10 dilution allowed distinguishing TB and NTB groups. The mean IgG level for 38-Da+LAM was significantly higher in the TB than that in the NTB group (P<0.0001). The mean IgA level for 38-kDa+LAM also was higher in the TB group (P<0.05). No difference was observed between TB and NTB groups in the titer of IgM antibodies. These findings indicate that TB is associated with the presence of detectable levels of antibodies in BALF. The antibody response is highly heterogeneous. This phenomenon results from the balance between pathogen and host immune system. The tests examined for detection of IgG in BALF can be used in combination with other diagnostic methods to increase diagnostic accuracy of pulmonary TB.

[Accuracy of treatment regimens performed in patients with culture positive pulmonary tuberculosis]

The key element in any tuberculosis control is the early diagnosis and prompt initiation of effective therapy. This is especially important in the smear-positive patients, who are the main source of infection in the community. A six month regimen comprising rifampin, isoniazid, pyrazinamide and ethambutol/streptomycin for the initial 2 months followed by rifampin and isoniazid for a next 4 months is the recommended standard treatment for pulmonary tuberculosis. The retrospective study was designed to investigate accuracy of treatment regimens performed in patients with culture positive pulmonary tuberculosis (CPPT). Medical records of patients with CPPT treated in Warsaw, Gdansk and Siedlce in 1995 and 2000 were reviewed. Median delay in the treatment of active tuberculosis was 16 days in 1995 and 11 days in 2000. In both study groups the most patients were given the standard treatment but in only 31.8% of cases in 1994 and 34.1% in 2000 duration of chemotherapy was in accord with current guidelines. In 60.3% of cases in 1995 and in 54.1% in 2000 the treatment was prolonged without obvious reason. This is demonstrating not satisfactory acceptance of short-course therapy by physicians. Treatment given too long increas the cost of therapy, lead to more side-effects and to poor patients compliance.

[Exogenous lipid pneumonia--a report of four cases]

Exogenous lipoid pneumonia (ELP) is a rare interstitial pulmonary disease caused by aspiration of the oily material. It is known to mimic many pulmonary diseases and causes many diagnostic difficulties. We present four patients with ELP. The clinical picture was very heterogenous. We described these cases to show that the use of the mineral oils may increase the risk of lipoid pnemonia.

[Pitfalls in the registration--why patients with culture positive pulmonary tuberculosis are not treated]

The treatment of patients with pulmonary tuberculosis is crucial element of tuberculosis control in the society. The reasons why patients with culture positive pulmonary tuberculosis (CPPTB) were not treated were assessed. The records of patients registered in the microbiological laboratories in Warsaw, Gdansk and Siedlce in 1995 and 2000 were analysed. There were found 373 patients with CPPTB in 1995 and 335 in 2000. In 11.5% of cases and in 13.4% respectively the treatment was not introduced. 37 patients in 1995 and 35 in 2000 were not treated because they were never registered in dispensary and never showed up there.

Cellular components of the bronchoalveolar lavage correlate with lung function impairment and extrapulmonary involvement markers in active sarcoidosis

Sarcoidosis is a chronic inflammatory multiorgan disease of unknown origin. Our previous study demonstrated a significant correlation between the relative count of non CD4(+), non CD8(+) lymphocytes in bronchoalveolar lavage of active sarcoidosis patients and proangiogenic activity of BAL homogenates. The aim of the present study was to evaluate in a group of 40 patients with active sarcoidosis the possible relationship between the intensity of alveolitis, particularly the non CD4(+), non CD8(+) lymphocyte subset, and other parameters characterizing the level of pulmonary (lung function tests) and extrapulmonary (spleen longitudinal dimension) disease activity. We found that the relative count of non CD4(+), non CD8(+) lymphocytes in BAL correlated positively with spleen size (r=0.50, P<0.01) and negatively with static compliance (r=0.43, P<0.05). We concluded that the lymphocytes belonging to the non CD4(+)non CD8(+) subset participate in the inflammatory process in sarcoidosis. However, more detailed phenotypic and functional characteristics of this cellular population are needed.

Diagnostic value of different serological tests for tuberculosis in Poland

The aim of the study was to test the diagnostic accuracy of several serological assays for the diagnosis of tuberculosis (TB) in the Polish population. ELISA based assays detecting: 38 kDa+LAM - MycoM, MycoA and MycoG, 38 kDa - Pathozyme TB complex, 38 kDa+16 kDa - Pathozyme TB complex plus were used. The humoral immune response was analyzed in a group of 319 TB patients (289 adults and 30 children) and in a control group consisting of 66 sarcoidosis cases, 16 cases of mycobacterial infections other than tuberculosis, 35 lung cancer patients, and 70 healthy volunteers. Among the TB patients, there were 267 cases of pulmonary TB and 52 cases of extrapulmonary TB. Sensitivity varied between 32% (IgM) and 63% (IgA) and increased in culture positive tuberculosis and in chronic cases. Specificity was the highest for the tests based on recombinant antibodies (98%). Sensitivity of the IgG test in extrapulmonary TB was comparable with that in pulmonary TB. Overall, sensitivity of the examined tests was lower in children than in adults, but it varied depending on the age and phase of the disease. We conclude that the ELISA-based tests may be a useful tool for improving the diagnosis of TB, especially in adults and in those countries where the prevalence of culture positive and chronic cases is high.

[Antimycobacterial antibody level in pleural, pericardial and cerebrospinal fluid of patients with tuberculosis]

The goal of the study was to evaluate IgG, IgA and IgM mediated humoral immune response against 38kDa and 16 kDa or 38kDa and LAM mycobacterial antigens in pleural, pericardial or cerebrospinal fluid from patients with tuberculosis (TB) and to compare to non-tuberculous controls (NTB). 30 cerebrospinal fluids (CSF) (16 TB pts and 14 NTB pts), 17 pericardial fluids (6 TB and 11 NTB) and 20 pleural fluids (7 TB and 13 NTB) were examined. Commercially available ELISA-based assays (Pathozyme Tb complex plus, Myco G, A and M--Omega Diagnostic) were used. Tests were performed and cut off established according to manufacturer instruction. Mean IgG level against 38 + 16kDa was significantly higher in neurotuberculosis group compared to control (p<0.05). Sensitivity of the test in detecting neurotuberculosis was of 42% and specificity of 96%. Mean IgG, IgA and IgM against 38kDa + LAM level was higher in TB group compared to NTB in CSF. No difference was observed between TB and NTB group in pleural effusion. Antimycobacterial antibody levels were non-significantly increased in pericardial fluid in TB. The findings of the study indicate that TB is associated with the presence of detectable levels of antibodies in the CSF and pericardial effusion. Anti 38kDa + 16kDa IgG test can be used in combination with other diagnostic methods to increase diagnostic accuracy of neurotuberculosis.

[Prognostic value of some clinical, radiological, laboratory and functional parameters in sarcoidosis]

Sarcoidosis is a granulomatous disease of unknown origin characterized by the trend to spontaneous remission in the great number of the patients. Some patients require treatment with corticosteroids, which have significant toxicity. The aim of this study was to assess the prognostic role of many different parameters in the patients with sarcoidosis. 162 sarcoidosis patients were introduced to prospective study: 22 patients were treated because of deterioration in lung function or serious ocular disease and 140 were observed without therapy for two years. We assessed the age, sex, symptoms, serum activity of angiotensin converting enzyme (SACE), hypercalcaemia, hypercalciuria, splenomegaly and HRCT findings at the time of diagnosis. We analyzed the frequency of spontaneous remission of sarcoidosis in the untreated patients. We investigated correlation between these parameters and remission. Statistical comparisons were made with chi-square test. We also applied the k nearest neighbor (k-NN) rule and the leave one out method adopted from the statistical pattern recognition theory. From many different parameters only acute symptoms (erythema nodosum, fever, arthritis) and serum activity of ACE might be helpful in predicting prognosis in the patients with stage I of disease. The patient's age at onset less than 36 years, the appearance of erythema nodosum and ground-glass opacities on HRCT scans portend an excellent prognosis in the patients with stage II of disease.

[Wegener's granulomatosis--disease course and treatment response of 18 patients]

Eighteen patients (12 female) with Wegener's granulomatosis (WG) treated from 1982-2001 were studied. Mean duration of patients' symptoms prior to diagnosis was 13.5 months, and mean age 41.2. Lung biopsy confirmed WG in 5 patients, nasal biopsy was made in 12, endobronchial in 3. In 11 of 14 patients cANCAs were found. Prednisone and 2 mg/kg/day doses of oral cyclophosphamide were used to treat 17 patients, prednisone was used alone for 1. Patients with severe symptoms were given i.v. 'pulse' methylprednisolone. Mean duration of treatment was 34.8 months and of follow-up, 71.9 months. A total of 4 patients died: 3 from complete renal failure. Four patients still undergo treatment, improving markedly. Complete remission was achieved in 6 patients. A total of 3 patients relapsed and are recently treated. In another one chronic renal failure developed. Three of them had moderate symptoms at diagnosis but were treated inadequately.

IN CONCLUSION

manifestation of WG and severity of symptoms may be different among patients. ANCA is not universally present in all patients with WG. The absence of ANCA does not exclude WG diagnosis. Complete remission can be achieved in WG patients, including the severely ill, if adequate therapy is given. Moderate symptoms at presentation do not justify less intensive treatment.

[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

[A case of multiple pulmonary hyalinizing granuloma]

Pulmonary hyalinizing granulomata are unusual, noninfectious lesions of the lung of uncertain etiology. The pathologic entity may represent a peculiar form of pulmonary immune reaction. We report the history of a 23-year-old woman who had nodular lesions in the right lung without any other abnormalities. Non-invasive procedures didn't yield diagnosis. Thoracotomy was performed. During intraoperative microscopic examination of one of 4 nodules, neoplastic disease was excluded. Remaining 3 nodules were also resected. The pulmonary hyalinizing granuloma was recognised in the histological examination. Follow-up after 12 months didn't reveal recurrence.

[Clinical presentation of own idiopathic pulmonary fibrosis patients according to international consensus statement]

Clinical presentation of idiopathic pulmonary fibrosis (IPF) restricted, according to current definition to usual interstitial pneumonia (UIP) was presented. 62 patients (39 males and 23 females) were assessed. The diagnosis of IPF/UIP has been based upon a combination of clinical, radiographic and physiologic features in majority of patients. Histologic confirmation from lung biopsy has been obtained in 16% of cases. Mean age of the patients was 64.4 +/- 8.0 years. Mean duration of symptoms was 20.1 +/- 14.1 months. The main symptom was exertional dyspnea. Crepitations were found in 98% of patients. Lung volumes were in normal range in substantial number of patients; TLC in 15 (24%) and FVC in 33 (53%) out of 62 patients. Disturbances of lung function concerned mainly gas exchange (DLCO diminished in 92% of cases) and lung compliance (diminished in all patients). Presentation of clinical, radiographic and physiologic features of IPF/UIP in a homogenous group of patients may be helpful in diagnosis of this common interstitial lung disease.

[Pulmonary lymphangioleiomyomatosis: presentation and results of treatment]

Lymphangioleiomyomatosis is a rare lung disease of unknown aetiology that affects only women. Eight premenopausal women with LAM confirmed by lung biopsy specimens were observed in 1984-2001. The most common presenting feature was exertional dyspnea (6) followed by chylous pleural effusions and pneumothoraces. In two women severe airflow obstruction was observed at presentation. HRCT revealed characteristic cysts in all cases. All women were given hormonal therapy (tamoxifen, medroxyprogesterone). The best results of treatment were achieved in cases with chylothoraces.

[Pulmonary actinomycosis as a complication of foreign body aspiration]

This first polish paper presents respiratory actinomycosis as a complication caused by aspiration of a foreign body. Aspiration of a citrus fruit stone occurred as a result of esophagus stenosis and dysphagia caused by a mistake made by a blind person of drinking a caustic substance. Clinical and bronchoscopic features suggested bronchogenic carcinoma but it's not confirmed by two histopathologic examinations of section from pathological bronchial changes. Diagnosis was based on the morphological picture of sections taken during third fibreoptic bronchoscopy and on cytological sputum examination. Removing the aspired foreign body from bronchus and prolonged penicillin treatment resulted in clinical and radiological amelioration.

[Atypical radiologic image of pulmonary sarcoidosis as a diagnostic problem]

Sarcoidosis is a multisystem disorder of unknown cause frequently presenting with hilar lymphadenopathy, pulmonary infiltration, ocular and skin lesions. Multiple circular or oval pulmonary dentisties appear in the less than 5% of patients. We describe 4 sarcoidosis cases with multiple or single tumor lesion. These patients were referred to our department with initial diagnosis of metastatic or primary lung malignancy. Two of them presented the picture of multiple tumors and two had single peripheral lung mass with hilar lymphadenopathy. This report shows difficulties in the diagnosis of the interstitial lung diseases when the radiological pattern mimics malignancy.

[Own experience in diagnosis and therapy in pulmonary Langerhans cell granulomatosis]

We have assessed 12 patients (2 females, 10 males) aged between 19 and 53 years (mean 38.3 +/- 10.3) diagnosed with LCG during 14-year period (1985-1998). All patients were smokers. Follow-up was from 6 to 132 months (mean 47.5 +/- 44.4). LCG diagnosis was confirmed by histology in 10 cases (9 lung, and 1 bone biopsy). In 2 patients the diagnosis was made on clinical grounds, including characteristic appearance on HRCT scans. Mean FVC was 78.9 +/- 15.9% of predicted, DLCO 64.1 +/- 22% of predicted. In 8 patients (67%) FVC or DLCO were below 80% of predicted. In 2 patients with histologically proven diagnosis, HRCT was not characteristic for LCG. The treatment was introduced in 8 patients (67%). Only 3 out of 8 patients initially treated with steroids responded to this treatment. In the rest treated patients, therapy was changed to cytotoxic agents. 3 patients died (1 after 2 years, and 2 after 11 years) 2 due to LCG and 1 due to pneumonia.

CONCLUSION

HRCT appearance is not always characteristic in patients with histological diagnosis of LCG. Pulmonary involvement in LCG is frequently connected with lung function derangements. Response to steroids is poor, and switching to cytotoxic agents is often necessary.

[Pulmonary alveolar proteinosis]

Pulmonary alveolar proteinosis (PAP) is a rare disease characterised by the accumulation of proteinaceous material within alveoli. In order to evaluate the clinical features and the course of PAP we reviewed 7 cases (2F/5M) diagnosed during a 11-year period (1989-1999). The mean age of patients was 40.7 +/- 11.2 years. Diagnosis was obtained by open lung biopsy in all cases. Clinical findings included dyspnea (43%), cough (28%) and crackles (28%). Lung function tests were normal in 5 cases and showed a moderate restrictive pattern in 1 and mild airflow obstruction in 1. Three patients had reduced Dlco (mean was 63% of predicted). Four patients had hypoxemia at rest. Chest X-ray revealed bilateral alveolar opacities (71%), involving perihilar areas and lower lobes. HRCT scans demonstrated diffuse ground glass opacities (83%) with interlobular septa thickening (50%). Three patients were treated with repeated segmental BAL (2 improved). The spontaneous partial remission occurred in 4.

[Clinical significance of pattern types in high resolution computed tomography images of patients with idiopathic pulmonary fibrosis]

The aim of the study was to assess significance of two types of HRCT pattern in patients with idiopathic pulmonary fibrosis (IPF), corresponding to usual interstitial pneumonia. The study population consisted of 34 patients, 11 women and 23 men, mean age 64.5 +/- 10.5 years. The patients were divided into two groups according to HRCT appearance: Group A--reticular pattern with some ground-glass attenuation (30 patients); group B--reticular pattern only (4 patients). Age, level of dyspnea, pulmonary function tests were similar in both groups. Longer history of dyspnea and more frequent finger clubbing (all patients) were found in Group B. 30 patients were followed-up for at least 12 months. In this period 4 out of 27 patients died in Group A, and 2 out of 3 patients died in Group B (p < 0.05).

CONCLUSION

HRCT showing reticular pattern only corresponds to late phase of IPF and is connected with very short survival.

[Value of the immunochromatographic assay for detecting IgG antibodies against 38 kDa mycobacterial antigen in diagnosis of tuberculosis]

Despite of a fast development in the techniques of rapid identification of mycobacteria by molecular genetic techniques, serodiagnosis may be of special values as non-expensive, easy to perform method. Several serodiagnostic tests, principally those using immunoenzymatic (ELISA) methodology are available. The goal of our study was to evaluate one step coloured immunochromatographic assay detecting IgG antibodies against antigen 38 kDa (Rapid Test TB). Our material consisted of 278 serum samples--tuberculosis (n = 155), healthy (n = 36), sarcoidosis (n = 50), lung cancer (n = 25) mycobacterial infections other than tuberculosis (n = 12). Tuberculosis group consisted of new culture positive cases (n = 66), new culture negative cases (n = 23), chronic cases (n = 43) and extrapulmonary TB (n = 23). Specificity of 96% and sensitivity of 54% was obtained. In pulmonary TB sensitivity of 50% and in extrapulmonary TB of 74% was obtained. In chronic cases sensitivity of 70% and in new cases of 40% was received. Sensitivity of 44% in new culture positive cases and 30% in new culture negative cases was obtained. We conclude that immunochromatographic test may be a very useful tool improving tuberculosis diagnosis, especially in extrapulmonary tuberculosis. Strip test may be an interesting alternative as it is an extremely simple, rapid, and cheap technique.