imageimageDNGR-1 (CLEC9A) is a C-type lectin receptor of type-1 conventional dendritic cells (cDC1s) with an important role in cross-presentation of dead cell antigens. This study explores how it equips cDC1s with the ability to cross-present such ...

Delayed pulmonary tuberculosis (TB) diagnosis, especially with limited bronchoscopy resources, worsens outcomes and increases transmission risks. Sputum induction offers a non-invasive and effective alternative. We investigated whether adding nebulized bronchodilators improves sputum induction effectiveness for presumed pulmonary TB.MethodsIn a randomized controlled trial at King Chulalongkorn Memorial Hospital, Thailand, 204 adults with presumed pulmonary TB and negative Xpert MTB/RIF Ultra results or inadequate sputum production were enrolled between July and October 2024. Participants were randomly assigned to conventional sputum induction (3% hypertonic saline alone; n=101) or bronchodilator-enhanced induction (nebulized bronchodilator plus 3% hypertonic saline; n=103). The primary outcome was TB diagnosis by Xpert MTB/RIF assay.ResultsTB detection rates by Xpert MTB/RIF were significantly higher in the bronchodilator-enhanced group (30.1%; number needed to diagnose [NND]=4) versus the conventional group (17.8%; NND=6), with a 12.3% difference (RR, 1.68; 95%CI, 1.01–2.80). The group receiving bronchodilator co-administration showed a trend towards higher mycobacterial culture positivity (RR 1.49; 95%CI 0.93–2.41) and a lower need for bronchoscopy (RR 0.41; 95%CI 0.15–1.12). They also experienced fewer adverse events and required fewer induction attempts, significantly assisting us to be able to provide early treatment to the patients (median 4.5 vs. 14 days; p<0.01). Subgroup analysis revealed a significant benefit among outpatients (RR 1.86; 95%CI 1.00–3.48).ConclusionBronchodilator-enhanced sputum induction demonstrated superiority over conventional induction, with higher diagnostic yield, fewer adverse events, fewer invasive procedures, and significantly earlier TB treatment initiation, supporting its potential as a new standard for TB diagnosis.Clinical Trials RegistrationThai Clinical Trials Registry (TCTR20240709001), registered on July 9, 2024.

Due to its poor bioavailability and urinary excretion, cefdinir may be a suboptimal agent for UTI treatment. Our findings demonstrate that patients treated