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Comparing Expectorated and Induced Sputum and Pharyngeal Swabs for Cultures, AFB Smears, and Cytokines in Pulmonary Nontuberculous Mycobacterial Infection
This study is currently recruiting participants.
Verified March 2012 by National Institutes of Health Clinical Center (CC)

First Received on June 24, 2010.   Last Updated on March 20, 2012   History of Changes
Sponsor: National Institutes of Health Clinical Center (CC)
Information provided by: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier: NCT01150721
  Purpose

Background:

- Pulmonary nontuberculous mycobacterial infection is a respiratory infection that is sometimes difficult to diagnose. Proper diagnosis depends on accurate collection of respiratory secretions, but these secretions may be contaminated by bacteria present in the mouth at the time of collection. In addition, some individuals may have difficulty providing respiratory secretions, because the infection affects lung function and sputum production. By collecting new samples from individuals who have already been diagnosed with this infection, and comparing the methods of collection, researchers hope to better understand and improve the ability to accurately diagnose and treat the infection at an early stage.

Objectives:

- To compare throat cultures and coughed-up and induced phlegm or sputum in individuals with pulmonary nontuberculous mycobacterial infection and inflammation.

Eligibility:

- Individuals between 18 and 79 years of age who have been diagnosed with pulmonary nontuberculous mycobacterial infection and are currently participating in selected NIH protocols on this infection.

Design:

  • The study will require a single 90-minute visit to provide research specimens.
  • Participants must not eat or drink for 2 hours prior to the collection of the early morning respiratory specimens. Blood pressure, temperature, pulse, breathing rate, and oxygen saturation level readings will be taken on the day of collection to ensure that participants may safely provide the specimens.
  • Participants will provide the following samples:
  • Blood sample: Participants will provide a blood sample to measure indicators of inflammation in the blood.
  • Throat swab: Participants will brush their teeth thoroughly before allowing researchers to swab the inside of their throat with a sterile swab.
  • Sputum collection (regular and induced): Participants will brush their teeth thoroughly and then provide both a regular sputum sample (produced normally) and an induced sputum sample (produced after using a nebulizer to stimulate sputum production).
  • No treatment will be provided as part of this protocol.

Condition
Pulmonary Nontuberculous Mycobaterium Infection

Study Type: Observational
Study Design: Time Perspective: Prospective
Official Title: Comparing Expectorated and Induced Sputum and Pharyngeal Swabs for Cultures, AFB Smears, and Cytokines in Pulmonary Nontuberculous Mycobacterial Infection

Resource links provided by NLM:

MedlinePlus related topics: Mycobacterial Infections
U.S. FDA Resources

Further study details as provided by National Institutes of Health Clinical Center (CC):

Estimated Enrollment: 160
Study Start Date: June 2010
Detailed Description:

In this protocol, a repeated measure design is used to examine microbial and molecular results in subjects with a diagnosis of pulmonary nontuberculous mycobacterial infection. Patients often experience difficulties in the spontaneous expectoration of sputum free from contamination with oral flora which contributes to the poor quality of some respiratory specimens sent to the laboratory. At present, it is not known how induced sputum, expectorated sputum, and pharyngeal swabs compare for acid fast bacilli (AFB) smear and culture results. Appropriate specimens are needed in the clinical setting for optimum diagnosis. In this study, procedures for the non-invasive collection of respiratory secretions will be used to decrease risk of specimen contamination.

Subjects who cannot produce respiratory secretions will be compared to patients who are successful. It is not known which factors prevent production of respiratory secretions for testing. Airway inflammation may contribute to difficulty in producing sputum along with dyspnea, phase of illness (newly diagnosed or chronic infection), treatment status, and respiratory condition severity.

Subjects will be characterized by phase of illness determined by health history and inflammation using common laboratory tests of inflammation. Respiratory specimens and blood will be collected for microbial testing and a portion will be stored then tested for analysis of pro-inflammatory cytokines (IL-1, IL-6, IL-8, TNF-alpha, & IFN-gamma). Clinical, demographic, laboratory, and patient subjective variables will be tested using regression statistical methods to determine predictors for specimen production success. Clinical variables to be tested include forced expiratory volume at one minute (FEV1) from a pulmonary function test (PFT), phase of illness and treatment, and age. The laboratory tests indicating inflammation include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Beta-2-Microglobulin (Beta-2M). Patient assessments for dyspnea will be evaluated using the Borg questionnaire.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:

Subjects must meet the following criteria to participate in this study:

  • Ages 18-99 years
  • Diagnosis of PNTM
  • Participating on an existing NIH protocol under Principal Investigators Kenneth Olivier MD and Steven Holland MD
  • Willing to allow the proposed protocol to use test results from the protocols of Kenneth Olivier MD and Steven Holland. These data include: AFB smear and NTM cultures, HIV testing by ELISA and Western blot testing, CRP, ESR, & Beta-2M, FEV1, and Borg and St. George's Respiratory Questionnaire results (Appendices D& E).

EXCLUSION CRITERIA:

  • Inability or unwillingness to provide any specimens: blood or respiratory (subjects able to provide blood and at least one type of respiratory secretions will not be withdrawn from the study)
  • Current medications of colony stimulating factors, IFN-gamma, TNF-alpha or monoclonal antibodies such as Rituximab within three months of this study

  • Vital signs falling beyond the following parameters prior to specimen collection procedures:

    1. Temperature (tympanic) greater than 101degrees Fahrenheit (38.3 degrees Celsius) pulse less than 51 per minute or greater than 124 per minute
    2. Respiratory rate less than 12 per minute or greater than 40 per minute.
    3. Oxygen saturation less than 92 percent
  • New (less than or equal to 30 days) tracheostomy tube, chest tube, or major surgery.
  • Current infection with TB or HIV
  • Any condition in the judgment of the investigators that would place subjects at risk or would jeopardize the study.

Participation of Children:

Children are not included in this study since the benefit versus the procedural burden of the protocol does not support their inclusion. Asking children to produce three respiratory specimens at a protocol visit is thought to be burdensome. Infants and young children cannot spontaneously expectorate. The main protocol upon which this protocol recruits only includes adults.

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01150721

Contacts
Contact: Ann M Peterson, R.N. (301) 451-1654 apeterson@cc.nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)     800-411-1222 ext TTY8664111010     prpl@mail.cc.nih.gov    
Sponsors and Collaborators
National Institutes of Health Clinical Center (CC)
Investigators
Principal Investigator: Ann M Peterson, R.N. National Institutes of Health Clinical Center (CC)
  More Information

Additional Information:
NIH Clinical Center Detailed Web Page  This link exits the ClinicalTrials.gov site

Publications:
Maliwan N, Zvetina JR. Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience. Postgrad Med J. 2005 Aug;81(958):530-3.
Flournoy DJ, Davidson LJ. Sputum quality: can you tell by looking? Am J Infect Control. 1993 Apr;21(2):64-9.
UMIKER WO, KORST DR, COLE RP, MANIKAS SG. Collection of sputum for cytologic examination: spontaneous vs.artificially produced sputum. N Engl J Med. 1960 Mar 17;262:565-6. No abstract available.

ClinicalTrials.gov Identifier: NCT01150721     History of Changes
Other Study ID Numbers: 100149, 10-CC-0149
Study First Received: June 24, 2010
Last Updated: March 20, 2012
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Atypical Mycobacterium Infection
Microbial Tests
Molecular Tests
Inflammation
Respiratory Secretions

Additional relevant MeSH terms:
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections

ClinicalTrials.gov processed this record on May 23, 2012



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