Routine Smear Research Articles

Indigenous Technique as an Effective Liquid-Based Cytology Tool for Multiple Single-Layered Cell Preparations.

Aims and Objectives:The aim of this work was to study the application of Modified Millipore technique (MMT) as a liquid-based tool to have multiple monolayer cellular smears for the routine cytology and Immunocytochemistry.Materials and Methods:In this study, we included 32 effusion fluid samples and 30 fine-needle aspiration cytology (FNAC) samples. From each of the samples, at first routine conventional smear was prepared. The residual samples were processed by MMT to make multiple smear preparation. Both the conventional and MMT of the monolayer cells were evaluated. The various cytomorphological features including the cellularity, background information, nuclear morphology, and cytoplasmic preservation were compared in these two techniques.Result:There were a total of 15 cases of fluid samples and 27 cases of FNAC. Statistical analysis of Mann–Whitney U test showed that the monolayer preparation by MMT and liquid-based cytology of fluid and FNAC smears are of same quality (P > 0.01).Conclusion:Monolayer preparation by MMT is cheap and effective. This technique can be used in routine laboratory for multiple monolayer cell preparations.

Incidental Detection of Microfilaria in Fine Needle Aspiration Cytology- A Report of Three Cases

Lymphatic filariasis, a major global health problem, is a mosquito-borne parasitic disease, encountered mainly in the tropics and subtropics. The disease is endemic in Southeast Asia, including the Indian subcontinent. It is transmitted by mosquitoes and is caused by the filarial nematodes Wuchereria bancrofti, Brugia malayi and Brugia timori. Usually, the infected person remains asymptomatic for years together and later manifests with features and consequences of lymphatic obstruction. The adult forms of the nematodes live in human lymphatics, whereas the infective larval form, the microfilaria circulates in the peripheral blood. The nocturnal periodicity of the microfilaria makes it challenging to detect in routine peripheral blood smear examinations. Also, it is quite unusual to find the microfilaria in fine needle aspirations. However, rare cases have been reported in certain unusual sites, like lymph nodes, cutaneous swellings, bone marrow, bronchial aspirate, breast, nipple discharge, cervicovaginal smears, pleural, pericardial, ascitic fluids, ovarian cyst fluids or even thyroid. Very few cases of microfilaria in thyroid aspirates have been reported till date. Also, it is unusual to find microfilaria in lymph node and breast aspirations. Herewith, three cases of microfilariasis are reported at three uncommon sites like thyroid, lymph node and breast.

Pelger-Huet anomaly: A Rare case report

Pelger-Huet anomaly (PHA) is a rare benign genetic disorder affecting terminal differentiation of granulocytes. Granulocytes have hyposegmented nuclei with normal cytoplasmic granularity and perform immune function. Knowledge about PHA is necessary to avoid misdiagnosis of hyposegmented granulocytes as increased band forms (bandemia) and to differentiate it from pseudo Pelger-Huet cells found in certain pathological conditions. Here, we report a case of PHA in neutrophils of a 46-year-old female found during routine peripheral smear examination. Further work up in family members revealed her siblings and her son were also having Pelger-Huet neutrophils in peripheral smear.

Clinical and histopathological profile of a patient with localized lepromatous leprosy

Lepromatous leprosy is a polar form of the disease characterized by very low to absent cell mediated immunity, resulting in unrestricted multiplication of the leprosy bacilli. This leads to infiltration and papulo-nodular lesions, which initially favor the cooler areas of the body and later become generalized. However, lepromatous leprosy may rarely be localized to a single or limited sites. Routine skin smears are negative but a skin smear and histopathology from the affected sites are confirmatory. These cases may be misdiagnosed as paucibacillary leprosy with subsequent under-treatment of the patient. Clinicians should be aware of this entity as a simple skin smear from the site can confirm the diagnosis. A 57-year old man presented with an erythematous plaque surrounded by a few satellite papules on the right hand, right ulnar paralysis and partial anaesthesia of the right hand and both feet, for one year. Slit skin smears from routine sites were negative for acid fast bacilli. However, a skin smear from the satellite lesions revealed a bacillary index of 4+. Histopathology of the skin was consistent with lepromatous leprosy. He was initiated on the WHO multibacillary multidrug therapy (MB-MDT).

A Rare Case of CNS Limited B-Cell Acute Lymphoblastic Leukemia Presenting as Acute Onset Psychosis

We report a case of a 52-year old male who presented with acute onset psychosis without any systemic symptoms or signs, with normal routine blood biochemistry, peripheral smear and radiological imaging of the brain. Diagnostic lumbar puncture and Flow cytometry of CSF revealed evidence of B-cell Acute Lymphoblastic Leukemia with 44.2% blast cells. Further workup with bone marrow examination was surprisingly normal. PET-CT did not reveal evidence of any malignancy in any organ system other than CNS. B-ALL presentation limited to CNS is rare, and with sole psychiatric manifestation without any focal neurological deficits, meningeal and or systemic signs is even rarer. This case will definitely widen the scope of differential diagnosis of a case of acute-onset psychiatric symptoms in middle to late age.

Frequency of Lentz Bodies Inclusion in Whole Blood Erythrocytes and Expanded Buffy Coat Smears

Background: Canine distemper has been classified as highly contagious for most of domestic and wild carnivores, and the infection can be fatal. Canine distemper inclusion bodies, also denominated Lenz inclusion bodies, are large aggregates of viral nucleocapsid particles that can be form in red blood cells (RBCs), white blood cells (WBCs) and epithelial cells in many tissues during the acute phase of infection. Their presence in blood is transient and rarely encountered in light microscopy but are pathognomonic when identified in blood smears. The objective of this study was to investigate the frequency of distemper inclusions in erythrocytes according to the fraction of the sample used for blood smears. Materials, Methods & Results: The study was conducted with routine blood sample provided by the Veterinary Laboratory of Clinical Analysis from the Veterinary Teaching Hospital of Universidade Federal do Rio Grande do Sul. The EDTA-K2 blood sample of a 40 days old male dog, mixed breed, no immunization records, presenting diarrhea, hyporexia, myoclonus and pustules in the abdomen, was selected. In a routine peripheral blood smear examination, several distemper inclusions were observed in the erythrocytes. From this sample, ten smears were performed using a whole blood (WB) and top erythrocyte fraction combined with buffy coat, denominated of expanded buffy coat (EBC). The EBC fraction was obtained after centrifugation of EDTA whole blood in microhematocrit tubes at 9600 x g for 5 min to obtained the packed cell volume (PCV) and buffy coat. After centrifugation, the blood cells are separated into three layers based on density: platelets (adjacent to supernatant), WBCs, and RBCs in the bottom. The PCV was measured and the microhematocrit tube was ruptured 2% below the interface between leukocytes and plasma, deposited into a plastic microtubes, homogenized and used for blood smear preparation. All smears were stained with Diff-Quick Stain. The frequency of observation of RBCs with distemper inclusions bodies was performed under optical microscopy, in the immersion objective (100x), accounting for complete fields up to a minimum of 1000 RBCs, and compared between WB and EBC. In comparison between blood smears obtained from WB and EBC, a highly significant difference (P = 0.0004) was observed in the frequency distribution of distemper inclusion. The median of frequency of RBCs with distemper inclusions in a WB smears was 12.68/1000 RBCs (10.1 - 16.1/1000 RBCs), with a coefficient of variation (CV) of 12%. Median of frequency of distemper inclusions from EBC smears was 54.23/1000 RBCs (45-77.9/1000 RBCs), CV of 18% were observed. The median frequency of inclusions found in EBC smears was 4.27 times higher than the WB smears. Discussion: Buffy coat smear providing a concentrated preparation of nucleated cells and this procedure is useful to looking for low-incidence infectious organisms or other hematologic alterations. The upper fraction of the RBC column, below the buffy coat, is composed of young RBCs. Selection of these portion, and their possible formed in the bone marrow viral replication phase, could justified the increase in the frequency of RBCs containing viral inclusions in EBC, which would also increase the sensitivity of the technique. EBC was homogenized previously to make the smears, certifying the adequate cell distribution in the slide surface without interfere with the frequency of distemper inclusion in RBCs observation. These results were confirmed with the coefficients of variation. In conclusion, distemper inclusions bodies in RBCs from EBC is a recommended diagnosis method in patients suspected of canine Distemper infection. The observation being more frequent in the EBC in comparison with WB, commonly used in veterinary hematology.

Application of sputum cell DNA ploidy quantitative analysis technique in early non-invasive screening of lung cancer

Objective To investigate the application value of sputum cell DNA ploidy quantitative analysis technique in early non-invasive screening of lung cancer. Methods The clinical data of 84 patients with lung cancer (lung cancer group) and 84 patients with benign lung disease (lung benign disease group) who were admitted to the Second Affiliated Hospital of Xuzhou Medical University from April 2016 to May 2017 were retrospectively analyzed, and 80 healthy subjects were selected as the control group. The sputum samples of all subjects were collected, and 55 corresponding lavage fluid samples in the lung cancer group were also collected. A fully automated cell tumor screening analysis system was used to make DNA ploidy quantitative analysis in all specimens, and the results were compared with sputum smear and liquid-based thin-layer cytology results. Results The positive detection rates of routine smear, liquid-based thin-layer cytology and DNA ploidy quantitative analysis in lung cancer group were 4.76% (4/84), 29.76% (25/84) and 45.24% (38/84). The positive detection rate of liquid-based thin-layer cytology and DNA ploidy quantitative analysis was higher than that of routine smear, and the differences were statistically significant (χ 2 = 18.38, P 0.05). Conclusions DNA ploidy quantitative analysis technique of sputum cells can directly reflect the malignant transformation of early lung cancer patients compared with traditional smear method and liquid-based thin-layer technology. Its positive detection rate is higher than that of the conventional detection method, which can be used as a valuable reference index for early screening of lung cancer. Key words: Lung neoplasms; Sputum; DNA ploidy; Diagnosis

New possibilities to diagnose pulmonary tuberculosis at a pulmonology inpatient department

The aim of the study was to investigate new methods for pulmonary tuberculosis (TB) detection at a pulmonology inpatient department.Methods. Pulmonary TB cases (n = 49) newly diagnosed at a pulmonology department of a hospital were involved in the study; among them, 69.4% of patients were infected with human immunodeficiency virus (HIV). All patients were asked if he/she had previously contacted with other TB patients, and if he/she was diagnosed with TB previously. The patients were also about family history. Posteroanterior and lateral chest X-ray and laboratory analyses were performed in all patients. Mycobacteria tuberculosis (MBT) were searched using smear microscopy, GeneXpert MTB/RIF molecular method and culturing (BACTEC MGIT) of sputum and bronchoalveolar lavage fluid (BALF) obtained during bronchoscopy. Patients with positive results only were included in the analysis in order to investigate and to compare diagnostic value of the methods.Results. Questioning patients at admission was useful to diagnose TB in 4% of patients. Sputum smears were positive in 12 patients (27.3%). BALF was obtained in 18 patients (36.7%); among them, MBT was identified in 52 (5%). Molecular testing was positive in all 49 patients (100%); among them, BACTEC MGIT culturing yielded MBT in 48 patients (97.9%). In patients with negative sputum smears during the first 3 days after admission, GeneXpert required 10.4 ± 5.3 days.Conclusion. GeneXpert method was highly useful to diagnose TB and was comparable with BACTEC. Routine sputum and BALF smear microscopy was significantly less rapid and less sensitive method. The diagnostic accuracy could be increased with the use of molecular methods in patients with negative sputum smears obtained at a general hospital. Therefore, molecular methods could be used in patients highly suspected for TB.

Intracytoplasmic crystalline inclusions in chronic lymphocytic leukemia.

Neoplastic B cells may have cytoplasmic inclusions that are visible in routine peripheral blood smears by light microscopy.

First Report of a Novel Hepatozoon sp. in Giant Pandas (Ailuropoda melanoleuca).

The first report of giant pandas (Ailuropoda melanoleuca) infected with a novel Hepatozoon species is presented. An intraleukocytic parasite was detected via routine blood smear from a zoo-housed giant panda at the National Zoological Park. Ribosomal DNA sequences indicated a previously undescribed Hepatozoon species. Phylogenetic and distance analyses of the sequences placed it within its own branch, clustered with Old World species with carnivore (primarily ursid and mustelid) hosts. Retrospective and opportunistic testing of other individuals produced additional positive detections (17/23, 73.9%), demonstrating 100% prevalence (14/14) across five institutions. All animals were asymptomatic at time of sampling, and health implications for giant pandas remain unknown.

Comparison of conventional polymerase chain reaction and routine blood smear for the detection of Babesia canis, Hepatozoon canis, Ehrlichia canis, and Anaplasma platys in Buriram Province, Thailand.

Background and Aim:Dog blood parasites are important tick-borne diseases causing morbidity and mortality in dogs worldwide. Four dog blood parasites species are commonly found in Thailand: Babesia canis, Hepatozoon canis, Ehrlichia canis, and Anaplasma platys. They are transmitted easily by tick species. However, there is little prevalence data available in Thailand. Diseases presentation of blood parasites infection is similar, but the treatment of each species is different. Current diagnosis mainly relies on microscopic examination of a stained blood smear, which has low sensitivity. Therefore, accurate diagnosis is important. This study aims to evaluate the efficacy of the conventional polymerase chain reaction (PCR) method and routine blood smears in the detection of four blood parasites species in dogs from Buriram Province, Thailand.Materials and Methods:In total, 49 EDTA-blood samples were collected from dogs in Buriram Province, Thailand. Blood parasite infection was compared using the Giemsa-stained blood smear technique to identify the parasite under a 100× oil immersion with PCR amplification of the 18S rDNA gene of B. canis and H. canis and the 16S rDNA gene of E. canis and A. platys.Results:Only one dog out of 49 was positive for H. canis based on microscopic examination whereas the PCR results showed that 2.04% (1/49), 4.08% (2/49), 36.73% (18/49), and 30.61% (15/49) of dogs were positive for B. canis, H. canis, E. canis, and A. platys, respectively. Moreover, coinfection was found in 16.33% (8/49) of dogs.Conclusion:This study is the first report to demonstrate the molecular prevalence of blood parasites in domestic dogs in Buriram Province. The results indicated that the PCR method exhibited much higher sensitivity and reliability for blood parasites diagnosis in dogs. Therefore, our data support serious concern regarding the diagnostic technique used in routine blood testing and also provide prevalence data for the management and control of blood parasites in this area.

Feasibility and Performance of Loop-Mediated Isothermal Amplification Assay in the Diagnosis of Pulmonary Tuberculosis in Decentralized Settings in Eastern China.

Early diagnosis is essential for the control and prevention of tuberculosis (TB). The objective of this study was to investigate the feasibility and performance of loop-mediated isothermal amplification (LAMP) in the diagnosis of pulmonary TB in county-level microscopy centers in Qingdao, Eastern China. A total of 523 presumptive TB patients were consecutively recruited between July 2017 and April 2018, and 22 patients were excluded from the analysis. Of 102 culture-positive cases, TB-LAMP identified 91 cases, demonstrating a sensitivity of 89.2%. In comparison, the sensitivity of routine smear microscopy was 69.6% (71/102), which was significantly lower than that of TB-LAMP (P=0.001). In addition, TB-LAMP sensitivities in smear-positive and smear-negative samples were 98.6% and 67.7%, respectively. In conclusion, our data demonstrate that TB-LAMP outperforms conventional smear microscopy in TB diagnosis, which could be used as an alternative method for smear microscopy in resource-limited settings in China.

Prevalence of Unsatisfactory Pap Smear and Associated Clinical History and Diagnosis in a Tertiary Teaching Hospital in Ghana

Background: A major limitation of cervical cytology is the unsuitability of proportion of smears submitted for analysis and for cytological assessment (unsatisfactory). This study examines the prevalence of unsatisfactory Pap smear, clinical history and diagnosis in the Department of Pathology, Korle-Bu Teaching Hospital (KBTH), Ghana. Materials and Methods: A retrospective review of 15,290 cases spanning 12 years (2005-2016) was carried out at the cytology unit of the Pathology Department of the KBTH. Out of the 15,290 Pap smear records retrieved, 2347 reports were excluded leaving 12,943 for the study. All unsatisfactory smear cases were analyzed and categorized using the Bethesda 2001 System. Results are presented using descriptive statistics. Results: The overall prevalence of unsatisfactory Pap smear was 402 (3.1%). Routine screening smear accounted for 115 (0.9%); reports without clinical history and diagnosis gave 21 (0.2%) and cases with clinical history and diagnosis were 287 (2.2%). The common cause of unsatisfactory Pap smear was scanty cellularity 222 (1.72%). Patient’s history accounted for the least cause of unsatisfactory Pap smear 2 (0.02%). Conclusion: Pap smear results reported as unsatisfactory could harbor cancer malignancy. Samples should be taken by well-trained persons.

The relationship between menopausal women infected with the human immunodeficiency virus and cervical atrophy: A cytologic study.

With the advent of combined antiretroviral therapy (cART), HIV positive women are expected to live longer. The effect of chronic HIV infection and cART on cervical epithelial maturation has not been well studied in postmenopausal woman. The objective of this study was to determine whether HIV positive postmenopausal women on cART show expected atrophic changes in cervical Pap tests. The maturation index (MI) was performed on routine cervical smears from HIV-infected, postmenopausal women attending an HIV clinic in a tertiary hospital in Johannesburg, over a 4-year period from January 2009 to December 2012. In Pap smears of 111 patients on cART, 58 (52%) showed an unexpected predominantly mature squamous epithelial pattern whereas 53 (48%) were predominantly immature or atrophic (P = .0001). There was no significant statistical difference in maturation according to cART use. HIV-infected, postmenopausal women in this study had reduced rates of cervical atrophy than expected, irrespective of cART use and CD4 count. Initiation of cART before menopause was associated with greater cervical epithelium maturation than those women who started cART after menopause. Additional, larger studies are required to confirm this novel finding and to investigate the reason for this phenomenon.

Can the leukocyte`s parameters in peripheral blood smear predict risk of in-hospital death of patients undergoing high-risk gastrointestinal surgery?

White blood cell (WBC) count constitutes a part of routine peripheral blood examination (FBC, full blood count). Precise analysis of leukocytes' parameters in blood smear is usually performed only when leukopenia or leukocytosis is found. We aimed to assess the usefulness of leukocytes' smear test in predicting in-hospital death of patients undergoing high-risk gastrointestinal (GI) surgery. Materials & Methods. We prospectively enrolled 101 subjects undergoing high-risk GI surgery from 01.01.2017 till 31.12.2017. Blood tests were performed preoperatively, with analysis focused on the assessment of total WBC count, as well as the count of neutrophils (NEUT), lymphocytes (LYM), monocytes (MONO), eosinophils (EOS) and basophils (BASO). Indices of NEUT/LYM (NLR) and MONO/LYM (MLR) were calculated. In-hospital mortality was considered the outcome. Mortality reached 5%. There was no significant difference in WBC count between survivors and the deceased (p=0.2) and WBC failed to predict the outcome (AUC=0.69; p=0.3). MONO (p=0.009) and BASO (p=0.02) counts, as well as MLR (p=0.007) were significantly higher in patients who died. MONO count and MLR index predicted in-hospital death with good accuracy, respectively: AUC[MONO]=0.85 (p<0.001) and AUC[MLR]=0.86 (p<0.001). Other investigated parameters played no significant role in outcome prediction. Routine peripheral blood smear evaluation should be considered in all patients undergoing high-risk GI surgery, because the number of monocytes can be a valuable predictor of in-hospital death.

Chest X ray score (Timika score): an useful adjunct to predict treatment outcome in tuberculosis.

Chest X-ray (CXR) has been used since long as an aid in the diagnosis of pulmonary tuberculosis (PTB) and also to determine the extent of the disease. The present study was conducted to evaluate the correlation of disease extent on CXR basing on the Timika CXR score with clinical and microbiological parameters at baseline, in sputum positive cases of pulmonary tuberculosis. The study was conducted at a tertiary referral centre for chest diseases in Bangalore, Karnataka from January 2017 to January 2018. This is a prospective study of new sputum smear positive pulmonary tuberculosis cases diagnosed in the department of Pulmonary Medicine. At baseline, patients' symptoms and signs on chest auscultation were recorded. The clinical scoring was done by the Karfosky performance score (KPS) and TB score I (Bandim TB score) and II. Baseline CXR- PA view of each patient was assessed independently by two chest physicians and evaluated by the Timika CXR scoring method. Routine blood investigations and sputum smear for acid fast bacilli were done. The correlation between the CXR score and other disease severity parameters was analysed. Clinical scores such as the KPS and TB score I (Bandim TB score) and II, did not correlate with the presence of cavitary disease on CXR (p > 0.05). 48.6% of patients with cavitary disease had higher baseline AFB density in sputum (i.e. sputum smear microscopy grade 3+) as compared to 40% of patients with non cavitary disease, which was not statistically significant. CXR score > 71 was significantly associated with longer duration of symptoms, higher clinical scores (KPS and TB score I, II) and lower Body Mass Index (BMI) at diagnosis of PTB (p < 0.05). 65.2% of the patients with CXR score ≤ 71 had significantly higher baseline AFB density as compared to only 32.4% with CXR result > 71 (p 0.04). CXR score > 71 also had significant association with higher ESR. Cavitary disease on CXR is associated with a higher mycobacterial load at baseline. The Timika CXR score is a simple, standard scoring system which can be used by a chest physician in a clinical setting. The CXR score significantly correlates with a broad range of clinical and microbiological measures of disease severity in PTB patients. Thus, it has a role in risk stratification, especially in patients not producing sputum or sputum negative PTB at diagnosis.

Assessment of the diagnostic value of immunocytochemitsry and in situ hybridization in cytological specimen of childhood leprosy

Background: Hardly any studies have been done to study diagnostic value of immunocytochemistry and in situ hybridization in cytological specimens for the diagnosis of leprosy in children. The objective of this study is to assess the diagnostic value of immunocytochemistry and in situ hybridization in cytological specimens of leprosy patients. To compare these techniques with Z.N. staining.Methods: This prospective study was carried out in 24 patients (≤18 years of age) of leprosy. Clinical examination of each patient was done and categorized according to IAL. After taking consent, three skin smears was taken, one for Z.N. staining and remaining two for immunocytochemistry and in situ hybridization respectively.Results: Routine skin smear examination by ZN staining method confirmed the diagnosis in 2/24 (8.3%) cases and they belonged to BL category. Immunocytochemistry showed positivity in 4/7 (57.1%) in early leprosy (BT) and 82.3% (BB/BL) in late leprosy. Immunocytochemistry improved the diagnosis by 66.7%, and the results were statistically significant (p&lt;0.01). In situ hybridization showed the positive results in 66.6% cases of early leprosy and 86.6% cases of late leprosy (BB/BL). In situ hybridization improved the diagnosis 72.6% in comparison to ZN staining and the results were statistically significant (p&lt;0.01).Conclusions: Immunocytochemistry and in situ hybridization enhance the diagnosis of leprosy when compared to routine skin smears stained by ZN staining. They are important diagnostic tools for definitive diagnosis in early as well as established cases of leprosy.

Severe Strongyloides stercoralis infection: a case report

This paper reports a severe case of Strongyloides stercoralis infection during routine sputum smear examinations, due to cough and shortness of breath, so as to improve clinicians' awareness of strongyloidiasis to avoid and reduce misdiagnosis and missed diagnosis.

Analysis of the causes of the misdiagnosis of hereditary spherocytosis

Hereditary spherocytosis (HS) is an inherited hemolytic disease with clinical diversities. The aim of the present study was to examine the reasons for prolonged misdiagnosis and mistherapy of HS in a Chinese patient, and to summarize the laboratory screening and treatment methods for this disease in increasing the knowledge towards HS. Clinical data of the proband was reviewed. The proband was first screened by detection of eosin-5'-maleimide (EMA)-labeled red blood cells (RBCs) using flow cytometry. The type of protein defect in the extracted RBC membrane proteins was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Mutant fragments were verified using direct DNA sequencing and matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectroscopy. The proband showed a significant hemolytic tendency and significant reduction in the number of EMA-labeled RBCs. DNA sequencing indicated three site mutations in the SPTA1 gene, including His54Pro, Leu1858Val and 6531-12C>T. Additional DNA analysis of the three mutations in the parents of the proband showed that both the Leu1858Val and 6531‑12C>T mutations were carried by the father and the His54Pro mutation was carried by the mother. Moreover, the mutated peptides were identified by MALDI-TOF mass spectroscopy. HS has diverse clinical manifestations and is easily missed, misdiagnosed and mistreated. Therefore, a comprehensive analysis involving a routine blood test, blood smear, EMA labeling (flow cytometry) and SDS-PAGE can effectively distinguish HS from thalassemia, glucose-6-phosphate deficiency, iron-deficiency anemia and autoimmune hemolytic anemia.

Diagnosis of Pulmonary Tuberculosis in less Sputum Producing or Sputum Smear Negative Cases: A Prospective Study in a Tertiary Care Hospital

Background: To Diagnosis of Pulmonary Tuberculosis in less Sputum Producing or Sputum Smear Negative Cases. Methods: 200 patients were included in this study with either no sputum or inadequate sputum (only saliva or sputum quantity < 2 ml) or whose initial two sputum smear examinations for AFB were negative, were included in the study. Results: Sputum induction was successful in 96% of patients who could produce adequate volume (> 2 ml). 4 males and 4 female patients having dry cough were unable to produce sputum even after induction. Overall, 47% of patients were found positive on smear examination after sputum induction. 68 patients out of 136 (50%), who were having sputum and were negative on routine smear examination, were found positive on induced sputum smear examination. Sputum induction was successful in confirmation of diagnosis in 40.62% (26/64) of patients who were having cough with no/inadequate sputum. Conclusion: This study revealed that this method useful and also enhance the sensitivity for diagnosis of tuberculosis. Background: To Diagnosis of Pulmonary Tuberculosis in less Sputum Producing or Sputum Smear Negative Cases. Methods: 200 patients were included in this study with either no sputum or inadequate sputum (only saliva or sputum quantity < 2 ml) or whose initial two sputum smear examinations for AFB were negative, were included in the study. Results: Sputum induction was successful in 96% of patients who could produce adequate volume (> 2 ml). 4 males and 4 female patients having dry cough were unable to produce sputum even after induction. Overall, 47% of patients were found positive on smear examination after sputum induction. 68 patients out of 136 (50%), who were having sputum and were negative on routine smear examination, were found positive on induced sputum smear examination. Sputum induction was successful in confirmation of diagnosis in 40.62% (26/64) of patients who were having cough with no/inadequate sputum. Conclusion: This study revealed that this method useful and also enhance the sensitivity for diagnosis of tuberculosis.