Abstract
Sputum microscopy is the primary diagnostic tool for screening pulmonary tuberculosis (PTB) suspects in TB prevalent countries. Our study had evaluated the ‘front loading’ or ‘same day’ sputum microscopy feasibility to screen clinically suspected PTB cases, in comparison to standard method of smear microscopy. In this hospital based cross-sectional study, three sputum specimens i.e., two consecutive spot samples collected in one hour interval on the first day of visit and a single sputum sample was collected on the next day early morning from 312 randomly selected adults suspected for PTB. Sputum samples were cultured on Lowenstein-Jensen (LJ) medium and stained by auramine O method and examined under LED-fluorescence microscopy. Out of 312 presumptive PTB patients, 43 (13.8%) were smear-positive by front loading method and 46 (14.7%) by standard method respectively. Considering LJ media culture as the gold standard test, the sensitivity was 83.7% and 89.8% respectively for front loading and the standard sputum microscopy and specificity was 99.2% by both methods. The statistical difference was insignificant between two methods of sputum microscopy (p-value > 0.05 by McNemar’s test). In health care settings of high burden countries same day sputum microscopy could be an acceptable method to screen the suspects of pulmonary tuberculosis and complete the diagnosis procedure on the first day of visit, which will decrease patients’ drop-out from the diagnostic procedure and initiate treatments as soon as possible.
Highlights
Tuberculosis (TB), an ancient disease still remains as greatest public health challenge in many parts of the world[1]
Our study had evaluated the ‘front loading’ or ‘same day’ sputum microscopy feasibility to screen clinically suspected pulmonary tuberculosis (PTB) cases, in comparison to standard method of smear microscopy. In this hospital based cross-sectional study, three sputum specimens i.e., two consecutive spot samples collected in one hour interval on the first day of visit and a single sputum sample was collected on the day early morning from 312 randomly selected adults suspected for PTB
In health care settings of high burden countries same day sputum microscopy could be an acceptable method to screen the suspects of pulmonary tuberculosis and complete the diagnosis procedure on the first day of visit, which will decrease patients’ drop-out from the diagnostic procedure and initiate treatments as soon as possible
Summary
Tuberculosis (TB), an ancient disease still remains as greatest public health challenge in many parts of the world[1]. Despite recent advances in diagnostic techniques, smear microscopy is the frequently used technique for screening pulmonary tuberculosis (PTB) suspects in TB prevalent and low-income countries[1]. According to RNTCP guidelines, whenever pulmonary TB is suspected, at least two sputum specimens should be collected over two consecutive days, i.e. one spot sputum sample at first day of visit and a single early morning sputum sample brought by patient day to health-care center[4]. It takes multiple visits to health care facilities and further delayed in start the treatment. This makes the diagnostic process costly and more inconvenient for patients, which leads to high drop-outs and spreads the disease. The undiagnosed patients often give rise to newer TB cases with high mortality[5]
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