Sputum Smear Examination Research Articles

P16.17 Correlation between demographics, clinical and risk factor for hiv infected with hiv/tb co-infected in amertha clinic kerti praja foundation bali

Introduction HIV infection increases the risk of developing Tuberculosis (TB), as TB infection increases the progression of HIV. In Indonesia, the rate of patients HIV positive with TB (HIV/TB co-infected) have reported 31.8% in 2013. In Bali HIV/TB co-infected patients have increased from 26% in 2012 to 30% in 2013. This study aims to determine the correlation between demographics, clinical and risk factor for HIV infected with HIV/TB co-infected in Amertha Clinic Kerti Praja Foundation Bali. Methods A cross-sectional study using secondary data of patients with HIV/AIDS who were receiving antiretroviral therapy (ART) from 2002–2012. Independent variables were demographics: sex, age, education level, occupation, and presence of ART supervisor; clinical: haemoglobin count, weight, and CD4 count; and risk factor for HIV infected. The status of HIV/TB co-infection was the dependent variable. All variables are conditions of patients when starting receiving ART. Data was analysed using univariate, bivariate (chi-square) and multivariate (cox regression). Results From the 531 patients, the majority were male (57,6%), aged ≥31 years (50,8%), and starting ART with median CD4 count 130 (IQR = 40–224) cell/mm3. We found 5,5% of patients experienced HIV/TB co-infection. In multivariate analysis, the variables was correlated with HIV/TB co-infection were a CD4 count at baseline ≤ 200 cell/mm3(PR = 10,34; 95% CI = 1,39–76,69) and patients with a history of injecting drugs compared to patients reporting heterosexual contact (PR = 3,27; 95% CI = 1,56–6,88). Conclusion Patients with CD4 count ≤ 200 cell/mm3 and patients with a history of injecting drugs have correlating with HIV/TB co-infection. These data support national recommendations encouraging early initiation ART when CD4 counts is higher. These data also suggests that promote awareness and monitoring patients with low CD4 count and who have a history injecting drugs for the presence of HIV/TB co-infection, particularly in those patients whose sputum smear examination or radiology was negative for TB. Disclosure of interest statement None.

Identifikasi Bakteri Tahan Asam (BTA) pada Pasien Suspek Tuberculosis di Puskesmas Ngronggot, Kabupaten Nganjuk, Jawa Timur

Tuberculosis (TB) is an infectious disease caused byMycobacterium tuberculosis that can invade the lungs as a primary infection which is a major health problem in developing countries. The purpose of this study to identification Acid Resistant Bacteria in patients with symptoms of tuberculosis in the region Ngronggot health center, district Nganjuk.
 This type of study was a descriptive study. The sample in this study is the sputum of patients with suspected tuberculosis. The study was conducted in district health centers Nganjuk Ngronggot on May 14 to June 30, 2012 were 116 patients with symptoms of cough for more than three weeks and gained 7.76% or 9 people who suffer from tuberculosis with positive sputum smear examination. And the obtained results of 92.24% or 107 people with negative sputum smear examination.

Enzyme-linked immunosorbent assay using Mycobacterium tuberculosis antigen 5 for the diagnosis of pulmonary tuberculosis in China.

Measurement of serum IgG antibody to Mycobacterium tuberculosis antigen 5 by enzyme-linked immunosorbent assay was evaluated as a serodiagnostic test for pulmonary tuberculosis in China. The test was 89% sensitive and 94 to 100% specific with high accuracies of prediction. Among 82 tuberculous patients, antibody titer was related to the extent of pulmonary disease. Among control subjects, false positive tests were encountered among 5 of 52 persons with other pulmonary disease and not among 30 healthy subjects. The characteristics of this test compare favorably with those reported for sputum smear examination.

Impact on Patients' Treatment Outcomes of XpertMTB/RIF Implementation for the Diagnosis of Tuberculosis: Follow-Up of a Stepped-Wedge Randomized Clinical Trial.

IntroductionThe impact on treatment outcomes of XpertMTB/RIF, a molecular-based test that provides rapid diagnosis of tuberculosis (TB) and rifampicin resistance with high accuracy, has not been reported despite its adoption in a few countries. We here report treatment outcomes in a step-wedged cluster randomized trial for patients diagnosed with XpertMTB/RIF compared to patients diagnosed with sputum smear examination in public health facilities in Brazil.MethodsTreatment outcome data were added to the trial database of patients diagnosed from 4 February to 4 October 2012, and crosschecked with data from the national mortality and the drug-resistant TB registers. Treatment outcomes in the intervention (n=2232) and baseline (n=1856) arms were compared using a multilevel regression model.ResultsUnfavourable outcomes were frequent in both arms, mainly due to loss to follow-up (16%). Overall unfavourable outcomes were not reduced in the intervention arm (29.6% versus 31.7%, OR=0.93; 95%CI=0.79-1.08). However, the overall TB-attributed death rate was lower in the intervention arm (2.3% vs. 3.8%). Adjusted for HIV status, age group and city, the intervention resulted in a 35% decrease in TB-attributed deaths (OR=0.65, 95%CI=0.44-0.97).ConclusionsThe proportion of patients successfully treated did not increase with Xpert MTB/RIF implementation, with high loss to follow-up rates in both arms. We did observe a 35% reduction in TB-related mortality, which we hypothesize may be explained by less advanced disease among the smear-negative patients diagnosed by Xpert. In conclusion, XpertMTB/RIF introduction did not improve TB treatment outcomes in Brazil.Trial Registrationclinicaltrials.gov NCT01363765

EXAMINATION OF TUBERCULOSIS OUTBREAK INDEX CASES IN OSAKA CITY

To analyze tuberculosis outbreak index cases in order to improve preventative measures. Outbreaks reported in Osaka City between 2008 and 2014 were investigated. The index cases were examined according to category group, sex, age, chest radiograph findings, sputum smear examination, patient delay, doctor delay, total delay in case finding, and adherence to regular health examinations. As controls, 467 patients in Osaka City with newly registered sputum smear-positive pulmonary tuberculosis in 2011 were included. Thirteen outbreaks occurred. The group categories included enterprises (9 outbreaks), preparatory schools (2), a junior high school (1), and other (1). The group of index cases consisted of 12 men (92.3%) and one woman (7.7%), with a mean age of 39.1 years; 11 (84.6%) were 30 to 50 years of age. Their ages ranged from 15 to 54 years. Of the control group of patients with sputum smear-positive pulmonary tuberculosis, 69.2% were 60 years or older, with a mean age of 65.4 years. These results suggest that the index case group was significantly younger (p < 0.001). There were ten cases (76.9%) of patient delay (initial visit 2 months or more after onset), and 8 (61.5%) of total delay (diagnosed 3 months or more after onset). These rates were significantly higher than those in the control group (p < 0.001). There were regular health examinations in four cases; among those, one did not see a doctor and another did not receive further examination. Chest radiographs revealed cavities in 12 cases (92.3%). All sputum smears were positive, with grades of 1 + in one case (7.7%), 2 + in two cases (15.4%), and 3 + in 10 cases (76.9%). These cases had a significantly higher rate of smear positivity than those in the control group (p < 0.001). The index cases were predominantly male, in their prime, and had higher infectivity rates. These findings suggest the importance of preventing delays in case findings and receiving regular and adequate health examinations.

Bernard–Soulier Syndrome (BSS) & tuberculosis: A case report

BackgroundBernard–Soulier Syndrome (BSS) is a rare congenital bleeding disorder characterized by thrombocytopenia. BSS causes bruising, epistaxis, gingival bleeding hemorrhage, post-partum bleeding, gastrointestinal bleeding and post-traumatic hemorrhage, but there is no report of hemoptysis in BSS. Case reportA 14-year-old girl was referred to this center due to massive hemoptysis. Her chest X-ray revealed complete collapse of the left lung. Rigid bronchoscopy was performed and the intrabronchial clots were removed. Smear and culture of direct sputum was positive for Mycobacterium tuberculosis. She received anti-tuberculosis treatment. During treatment, she developed massive vaginal bleeding, because of drug interaction between rifampin and low dose contraceptive (LD), which she had been taking for control of massive menstrual bleeding. Her vaginal bleeding was controlled by platelet infusion and recombinant factor 7 infusion. After two months of anti-TB treatment, the sputum smear and culture examination became negative. One year after treatment, the pulmonary tuberculosis was completely cured and no hemoptysis occurred. ConclusionWhen hemoptysis occurs in patients with BSS, other differential diagnoses should also be considered.

Comparison of epidemiological, clinical, laboratory and radiological features of hospitalized diabetic and non-diabetic patients with pulmonary tuberculosis at razi hospital in ahvaz.

Background:Diabetes mellitus (DM) due to suppressive effect on cellular immunity can impact on progression of tuberculosis (TB).Objectives:The aim of this study was to investigate the impact of DM on the epidemiological, clinical and para clinical aspects of pulmonary TB.Patients and Methods:The information of 148 admitted pulmonary TB patients in infectious ward of Razi hospital in Ahvaz from 2009 to 2010 was extracted from their medical files. The patients were divided into two groups as TB with DM (n = 36) and TB without DM (n = 112). The related data on epidemiology, signs, symptoms, radiology and sputum smear examination in both groups were compared in SPSS 16 by using chi squared test.Results:The mean age of TB with DM patients was higher TB without DM patients (56.6 ± 12.7 vs. 44.8 ± 18.3; respectively, P = 0.006). Whereas cough, night sweating, fever and weigh loss was not statistically different, sputum, hemoptysis and dyspnea was more prominent in TB with DM (69.4%, 33.4%, 44.5% vs. 36.6%, 9.8%, 20.5%; P = 0.005, P = 0.001, P = 0.005, respectively). In chest x-ray, cavitation and reticulonodular pattern was more frequent in TB with DM (55.5%, 22.2% vs. 31.2%, 8% - P = 0.008, P = 0.02, respectively). The rate of sputum smear positivity in TB with DM and TB without DM was 66.6% and 47.3%, respectively (P = 0.03).Conclusions:According to the results of this study, in approach to every DM cases suffering of respiratory symptoms such as productive cough, hemoptysis and dyspnea in association with cavitation or miliary mottling in chest x-ray, pulmonary TB should be considered at the top of the differential diagnosis list.

Prevalence of national treatment algorithm defined smear positive pulmonary tuberculosis in HIV positive patients in Brazzaville, Republic of Congo.

BackgroundIn the Republic in Congo, the national algorithm for the diagnosis of pulmonary tuberculosis (TB) relies on Ziehl-Neelsen (ZN) sputum smear microscopy, chest X-ray radiography (CXR) and clinical symptoms. Microscopy positive pulmonary TB (MPT+) is defined as symptoms of TB and a positive ZN smear. Microscopy negative pulmonary TB (MPT-) is defined as symptoms of TB, a negative ZN smear but CXR changes consistent with TB. The present cross-sectional study was designed to determine the prevalence of positive and negative MPT individuals among HIV positive and HIV negative individuals presenting to an ambulatory TB treatment center (CTA) in Brazzaville.MethodsAll study participants underwent a physical examination, chest radiography and three ZN sputum smear examinations and HIV testing. Viral load and CD4 counts were determined for HIV positive individuals.Results775 individuals presented with symptoms of TB. 425 individuals accepted the voluntary HIV test. 133 (31.3%) were HIV positive (HIV+) and 292 (68.7%) were HIV negative (HIV-). Of the 292 HIV- individuals 167 (57%) were classified as positive MPT and 125 (43%) as negative MPT. Of the 133 HIV positive individuals 39 (29%) were classified as MPT + and 94 (71%) as MPT-.ConclusionOur study shows that the prevalence of positive MPT individuals is lower among HIV positive individuals compared to HIV negative individuals in agreement to reports from other countries. The data suggest that a substantial number of HIV positive pulmonary TB cases are not detected by the national algorithm and highlight the need for new diagnostic tests in this population.

Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia.

BackgroundStudies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors.MethodsAll new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients’ perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.).ResultsDuring the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment.ConclusionIn relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.

English

The study entitled “A Study on Performance of DOTS in a Private Medical College Hospital” was conducted in the area of ELURU town which is served by DMC of ASRAM Medical College to assess the performance of RNTCP at a premier tertiary level hospital of the state of Andhra Pradesh. This was both a hospital and community based prospective and follow-up study. Different technical indicators were considered to analyze the findings. Reference for sputum examination from ASRAM OPD (which include pulmonary medicine OPD) is 2.34% which is according to RNTCP norm>2%. Among the total new OPD registrations, 2.31% were chest symptomatic in the year 2011 and had undergone sputum smear examination for AFB. Among them 13.31% were detected to be sputum positive.91 of 122 cases that were diagnosed at ASRAM Medical College to be new smear positive were either referred to or transferred out to other DMC or TU respectively for DOTS. Ratio of patients among different categories in present study is found to be Cat-I: Cat-II is: 4.27:1 Retreatment case load of this DMC was 19% (RNTCP norm: ≤ 30%). A total of 58 patients had been registered in 2011 for DOTS under DMC of ASRAM Medical College. Among them 43 (74.13%) were males and 15 (25.86%) were females. Most of them (51.72%) belong to socio-economically productive age group of 15-44 years. 65% of study subjects are illiterate or have low level of literacy which has a significant role in the spread and prevention of the disease in the community.68.97% of cases belong to low socio-economic class which indicates that this disease still exists as a disease of poor men.

Evaluation of Active Pulmonary Tuberculosis Among Patients With Diabetes

Background: According to several studies, diabetes mellitus has been recognized as one of the main risk factors for pulmonary tuberculosis (PTB). Objectives: The main purpose of this study was to determine the frequency of smear-positive pulmonary tuberculosis (TB) in patients with diabetes. Materials and Methods: This cross-sectional study was conducted from April 2010 to December 2011 in Ali Asghar Diabetes Center of Zahedan, Iran. Standard chest radiography and sputum smear examination were performed on patients with diabetes who had signs and symptoms of tuberculosis. Cases of active TB were identified and referred to directly observed treatment, short-course (DOTS) centers. In addition, a purified protein derivative (PPD) skin test was done for all patients. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software with chi-square and fisher exact test in cross tabulation. Results: Of the 400 patients with diabetes, 24 (6%) patients were suspected to have active PTB, yet laboratory paraclinical examinations revealed 4 cases of smear-positive pulmonary TB. The result of the PPD test was negative (induration of 0-4 mm) in 257 (64.25%) patients, intermediate positive (induration of 5-9 mm) in 118 (29.5%) and positive (induration of 10-14 mm) in 25 (6.25%) cases. Conclusions: The results of this study indicate high frequency of smear-positive TB in patients with diabetes, compared with expected cases in the community and global population. Thus, screening of tuberculosis in patients with diabetes is recommended for the control and successful treatment of the two diseases.

Does task shifting in tuberculosis microscopy services to non-certified technicians in Afghanistan affect quality?

Tuberculosis microscopy centres in 30 provinces in Afghanistan. To compare the quality of sputum smear examinations in microscopy centres with microscopists who are fully certified as laboratory technicians with those performed in centres with technicians who do not have such certification (high school graduates). Cross-sectional record review of sputum smear microscopy slides examined by technicians and cross-checked by trained assessors as part of routine external quality assurance between July and September 2009. Of 129 non-certified technicians, 118 (91%) were stationed in rural health centres compared with 217/257 (84%) certified technicians. From 386 microscopy centres, 7313 slides were cross-checked. Of 257 microscopy centres with certified technicians, 42 (16%) had at least one slide with a major error compared to 23 (18%) of 129 microscopy centres staffed with non-certified technicians. The difference was not statistically significant (OR 1.11, 95%CI 0.64-1.94). The number of slides showing major errors was also similar between the centres with both certified and non-certified technicians. This study confirms the deployment of non-certified microscopy technicians to peripheral health centres throughout the country and that their performance with sputum smear microscopy is similar to that of certified technicians with 3 years of training.

Derivation, validation and comparative performance of a simplified chest X-ray score for assessing the severity and outcome of pulmonary tuberculosis

To derive and validate against the Ralph et al. score, a simplified chest X-ray (CXR) score (SCS) for predicting the outcome of smear-positive pulmonary tuberculosis (SPPTB) among patients with high prevalence of human immunodeficiency virus (HIV) infection. CXR for 636 SPPTB patients (377 men, median age 31 years) from the Yaounde Jamot Hospital (Cameroon) were examined for the presence of tuberculosis lesions, and estimation of the proportion of lungs affected. SPPTB's evolution was based on sputum smear examination after 2 months of treatments. Logistic regressions were used to derive the SCS with internal validation via bootstrap resampling. Receiver operating characteristic curves (AUC) analyses were used to validate, determine of the optimal cut-offs and compare models' performance. HIV co-infection was present in 191 (30%) patients. Sputum smear non-conversion was found in 45 (7.1) patients after 2 months of treatment. The SCS was expressed as proportion of lung affected plus 23 if cavitation is present. The AUC (95% confidence interval) was 0.718 (0.640-0.795), with little variation in bootstrap validation, and no sizable difference from the Ralph et al. model [0.714 (0.633-0.7860), P = 0.717 for the difference). Both models had good calibration (Hosmer-Lemeshow P ≥ 0.183). The optimal cut-off for predicting non-conversion of the sputum at 2 months was 52 for the SCS (sensitivity/specificity 66.7%/62.8%) and 74.5 (62.2%/74.3%) with Ralph et al. score. The outcome of SPPTB among patients with high prevalence of HIV can acceptably be predicted by simple scores comprising baseline CXR variables, including the Ralph et al. score and the SCS from this study.

Role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP

Background: Microbiological diagnosis is the main stay for the effective treatment of pulmonary tuberculosis. About 31%of the new cases may be smear-negative for AFB. Difficulties arise when a patient who is suspected of active tuberculosis, both clinically and radiologically, does not produce sputum or when it is available AFB may be negative. Fiberoptic bronchoscopy offers a mean of investigation whereby bronchial secretion and washing can be collected from the most likely abnormal site under direct vision. Aims & Objective: To study the role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP. Material and Methods: Thirty three patients aged Above 18 years old who were suspected of having pulmonary tuberculosis based on clinical and radiological appearances were prospectively studied. All subjects had at least 2 sputum smear examination which were negative for acid fast bacilli according to the revised national tuberculosis control program (RNTCP). The bronchoscopy was performed transnasally using fujinon bronchoscope by 2 bronchoscopists under local anaesthesia. A thorough examination of bronchial tree was carried out and bronchial aspirate (BA) bronchoalveolar lavage (BAL) bronchial brushing, transbronchial lung biopsy (TBLB) and post bronchoscopy sputum (PBS) were collected. The specimen obtained was placed on slides for Ziehl-Nielsen stain. Bronchial biopsy was performed on abnormal looking mucosa and stained with Eiosin-hematoxylin and Ziehl- Nielsen stains. Results: In total 33 sputum smear negative suspected pulmonary tuberculosis cases, at microscopy centre under RNTCP, early diagnosis of pulmonary tuberculosis was established in 10 (30.30%) cases and in 3 (9.09%) cases diagnosis of malignancy was established. Conclusion: Fiberoptic Bronchoscopy is a useful procedure to establish the diagnosis of pulmonary tuberculosis when sputum smear examination does not show acid fast bacilli. This allows appropriate treatment to be started with confidence.

Study of treatment interruption of new sputum smear positive TB cases under DOTS strategy

Background: In 1993 GoI launched RNTCP and adopted DOTS-Strategy, to revitalize the TB control programme in India. Aims & Objective: This study attempts to find out the prevalence and reasons for non-adherence /non-compliance to DOTS. Materials and Methods: Community based prospective observational study was conducted with 281 newly diagnosed sputum positive TB cases. The follow-up sputum examination, interruption from treatment and reasons for non-adherence details were obtained at the end of the 2nd, 4th & 6th month for sputum smear negative TB cases and 5th & 7th month for sputum smear positive TB cases. Results: Study shows 25% of the cases did not report for follow up sputum smear examination after intensive phase and 50% of the cases at the end of follow up. Main reasons for not attending the follow-up sputum smear examination were lack of awareness (45%) and workload (31%). During the treatment period, 28 % were interrupted in intensive phase and 40% interrupted in continuation phase and 29% were defaulters. The reasons for treatment interruption were adverse effects (39%), lack of personal interest (27%) and work load (27%). Treatment interruption was more in age group of 0-50 years (74.87%), male (74.54%), illiterate (77.38%) and labourers (75.32%). Conclusion: Noncompliance was found to be mainly due to lack of unawareness, lack of time, side effects of medicines, which can be modified by IEC and focus service delivery on high risk groups.

QuantiFERON®-TB gold in-tube is not Useful for Diagnosing Active Tuberculosis in HIV/AIDS Patients with Severe Immunodeficiency: Results from Brazil

Purpose: To assess interferon gamma release assay (IGRA) and tuberculin skin test (TST) performances in the diagnosis of active tuberculosis (TB) in adults with HIV/AIDS with different degrees of immunodeficiency. Methods: Cross-sectional study conducted with 90 HIV/TB-coinfected adults, Sao Paulo, Brazil. TB diagnosis was established based on the presence of positive sputum smear, culture, or anatomic-pathological examination. The participants responded to a questionnaire and were submitted to physical examination, chest x-ray (CRX), serum CD4+ and CD8+ T cell count, TST, and IGRA (QuantiFERON®-TB Gold In Tube, Cellestis, Carnegie, Australia). Results: Characteristics of 90 HIV/TB-coinfected individuals: male (60.0%), white (54.4%), single (57.3%), and average age 39 (±10.8) years with pulmonary TB (45.6%) and average CD4+ T-cell count (198.92 cells/mm3). TST was positive in 25.56%, and IGRA was positive in 65.56%. IGRA performance was better when compared to TST (p<0.001) and was able to diagnose TB with 93.75% probability when CD4+ ≥ 187 cells/mm3 ; TST showed similar efficacy when CD4+ ≥ 500 cells/mm3 . Conclusion: IGRA exhibited better performance for TB disease diagnosis in HIV-infected individuals with severe immunodeficiency when compared to TST. Nevertheless, both tests may exhibit false-negative results in this type of population. Despite the fact that IGRA has better performance than TST in the diagnosis of active TB in patients with HIV/AIDS, the practical utilization of the method seems to be limited and should be considered only for patients with CD4+ ≥ 187 cells/mm3.

A comparative study of pulmonary Koch′s among marble stone worker community of Bhedaghat and nonmarble stone worker community of Garha

Introduction: Occupational stone dust exposure may result in several health risks tuberculosis (TB) silicosis, obstructive as well as restrictive lung diseases, among which TB is more prevalent in developing countries like India. Most people residing in Bhedaghat engaged in carving statues from variable stones and marble rocks belongs to poor socioeconomic conditions and unaware of the preventive measures. Ultimately they end up in chronic respiratory problems and various complications. Objective: The study was carried out to find the effect of marble stone dust exposure on the prevalence of TB and to study some of associated epidemiological factors and effect of working environment. Materials and Methods: The present study is cross-sectional study with a comparison group, which was matched for age, sex and socioeconomic status, unexposed to similar working environment, that is, carving and cutting marble stones. Using interview technique demographic, occupational and clinical details were recorded on the predesigned proforma. For pulmonary TB among study subjects already detected, cases were included, and those strongly suggestive on the basis of clinical history were confirmed by means subsequent sputum smear examination and radiography. Statistical analysis was carried out by using Statistical Software Package Epi Info 7. Results and Conclusion: Overall prevalence of pulmonary TB was 6.25% among marble stone workers while in the comparison group it was 4.38%. Among marble stone workers, the prevalence was more among workers working in closed and congested room and not using any personal protective measures and employed in stone cutting for >5 years.

LED-fluorescence microscopy for diagnosis of pulmonary tuberculosis under programmatic conditions in India.

BackgroundLight-emitting diode fluorescence microscopy (LED-FM) has been shown to be more sensitive than conventional bright field microscopy using Ziehl-Neelsen (ZN) stain in detecting sputum smear positive tuberculosis in controlled laboratory conditions. In 2012, Auramine O staining based LED-FM replaced conventional ZN microscopy in 200 designated microscopy centres (DMC) of medical colleges operating in collaboration with India’s Revised National Tuberculosis Control Programme. We aimed to assess the impact of introduction of LED-FM services on sputum smear positive case detection under program conditions.MethodsThis was a before and after comparison study. In 15 randomly selected medical college DMCs, all presumptive TB patients who underwent sputum smear examination in the years 2011 (before LED-FM) and 2012 (after LED-FM) were compared. An additional 15 comparable DMCs that implemented conventional ZN sputum smear microscopy were also selected for comparison between 2011 and 2012.ResultsThe proportion of presumptive TB patients (PTP)found sputum smear positive increased by 30%- from 13.6% (3432/25159) in 2011 to 17.8% (4706/26426) in 2012 (P value <0.01) in the sites that implemented LED-FM microscopy, whereas in DMCs where the ZN staining procedure is followed the proportion of sputum smear positive had remained unchanged (13.0%versus 12.6%;P value0.31).ConclusionUse of LED-FM significantly increased the proportion of smear positive cases among presumptive TB patients under routine program conditions in high workload laboratories. The study provides operational evidence needed to scale-up the use of LED-FM in similar settings in India and beyond.

Tuberculosis Management Practices by Private Practitioners in Andhra Pradesh, India

SettingPrivate medical practitioners in Visakhapatnam district, Andhra Pradesh, India.ObjectivesTo evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC.DesignCross- sectional survey using semi-structured interviews.ResultsOf 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine.ConclusionFew private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.

Assessing the effectiveness of Directly Observed Therapy short-course (DOTs) for tuberculosis in a Nigerian hospital

This study was set out to determine the effectiveness of Directly Observed Therapy, short-course (DOTs) for tuberculosis, and to compare the effectiveness of DOTs with Non-DOTs in Plateau State Specialist Hospital, Jos Nigeria. Retrospective data made up of 241 DOTs treatment cards from February 2001 to September 2002 and 128 Non-DOTs medical files of in-patients from 1993 to 2000 was collected and analyzed using ANOVA with the aid of statistical package IBM-SPSS Version 19.0. Majority of TB cases occurred between ages 21-30 (28%) in both DOTs and Non-DOTs cases, while the least occurred in the extreme of ages (very young and old, 1.2% -5.5%). There were more males than females with TB in both cases (59% males, 41% females-DOTs; 65% males, 35% females-Non-DOTs). Civil Servants had the highest incidence of TB in DOTs (25%) while the unskilled and semiskilled workers had the highest incidence in Non-DOTs (21%). Majority of the DOTs patients were diagnosed by sputum smear examination (84%), while most of the Non-DOTs patients were diagnosed by chest X-ray (89%). Successful treatment in terms of treatment completed and cured was 67.2% for DOTs and 64.1% for Non-DOTs, giving a percentage difference of 3.1%. There was no significant difference in the percentage difference. An integration of the strengths of both programs should be employed to improve patient adherence and other treatment outcomes.Keywords: DOTs; Non-DOTs; Tuberculosis treatment outcomes.