Microorganisms isolated at admission and treatment outcome in sputum smear-positive pulmonary tuberculosis

Background: Immune status of a patient influences the susceptibility, clinical presentation of tuberculosis and its treatment outcome. Some of the most common conditions associated with immune deficiency includes, human immunodeficiency virus (HIV) infection, diabetes and chronic steroid therapy for any underlying diseases.Methods: A cohort study, enrolled patients with tuberculosis alone (n=51) and those with tuberculosis and immunosuppressed state (patients with HIV, diabetes and those on steroid therapy, n=97).Results: All patients received Directly Observed Treatment Short course (DOTS) regimen implemented through RNTCP. Among the immunosuppressed patients, 32 were HIV patients, 45 of them were diabetic and 20 received chronic steroid therapy. All immunocompetent patients (control) were totally cured but 62.5% and 88.9% of HIV and diabetic patients in the immunosuppressed group were cured. Mortality was high in the immunosuppressed group (18.75% in HIV, and 11.11% in diabetic group). The grade of sputum smear had significant influence on the treatment outcome after adjusting for death and default (p>0.05). After intensive phase, the smear conversion rate were 86.27% in the control group,37.5% in the HIV patients, 22.22% in diabetics and 55% among chronic steroid use. The mortality and cure rate among those who received treatment for diabetes mellitus is comparable with that of immunocompetent group. Treatment prolongation was required for patients in the immunosuppressed group (62.5% in HIV group, 77.7% in diabetes group and 45% in chronic steroid users group).Conclusions: Immunosuppression was a risk factor for increased morbidity and mortality among new smear positive pulmonary tuberculosis patients. Prolonged DOTS regimen requires long-term close follow-up of patients who are immunocompromised.

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Cost-effectiveness of chemotherapy for sputum smear-positive pulmonary tuberculosis in Malawi, Mozambique and Tanzania

The International Journal of Health Planning and Management ◽

10.1002/hpm.4740090204 ◽

1994 ◽

Vol 9 (2) ◽

pp. 151-181 ◽

Cited By ~ 13

Author(s):

Eric De Jonghe ◽

Christopher J. L. Murray ◽

H. J. Chum ◽

D. S. Nyangulu ◽

A. Salomao ◽

...

Keyword(s):

Cost Effectiveness ◽

Pulmonary Tuberculosis ◽

Sputum Smear ◽

Smear Positive Pulmonary Tuberculosis

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Factors Influencing Sputum Conversion among Smear-Positive Pulmonary Tuberculosis Patients in Morocco

ISRN Pulmonology ◽

10.1155/2013/486507 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Khalid Bouti ◽

Mohammed Aharmim ◽

Karima Marc ◽

Mouna Soualhi ◽

Rachida Zahraoui ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Stepwise Regression ◽

Control Measures ◽

Sputum Smear ◽

Tuberculosis Patients ◽

Infection Control Measures ◽

Factors Influencing ◽

Smear Positive Pulmonary Tuberculosis ◽

Sputum Conversion ◽

A Prospective Study

Background. Sputum smear-positive pulmonary tuberculosis patients expel infectious viable bacilli for a period following the commencement of treatment. Objective. To determine the time to sputum smear conversion and study the factors influencing it. Design. A prospective study was undertaken at our hospital in Rabat over a six-month period on a cohort of 119 sputum smear positive patients. Patients were followed up fortnightly. At each followup, specimens were collected and processed for microscopy using standard protocol. Results. 96.6% of our patients completed the study (4 deaths). Sputum conversion rate was 42% after two weeks, 73% after one month, and 95% after two months. Univariate and stepwise regression analysis showed that patients who had high smear grading, miliary, and bilateral radiologic lesions were more likely to undergo delayed sputum conversion (P<0.05). Other factors were thought to influence sputum conversion but were not statistically proven in our study. Conclusion. Since viable bacilli continue to be expelled for up to two months, infection control measures should be maintained for such a time. Patients with high smear grading, miliary, and bilateral radiologic lesions need to be monitored more closely.

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Sputum Smear Positive Pulmonary Tuberculosis Diagnostic Dropout Rate in Public Health Facilities, Addis Ababa, Ethiopia

Pulmonary Medicine ◽

10.1155/2019/2905615 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Daniel Melese Desalegn ◽

Kumera Terfa Kitila ◽

Boja Dufera Taddese ◽

Tinsae Kidanemariam Hailu ◽

Tariku Takle Dinku ◽

...

Keyword(s):

Public Health ◽

Pulmonary Tuberculosis ◽

Addis Ababa ◽

Dropout Rate ◽

Sputum Smear ◽

P Value ◽

Smear Microscopy ◽

Sputum Smear Microscopy ◽

Public Health Facilities ◽

Smear Positive Pulmonary Tuberculosis

Background. Prolonged laboratory diagnostic process of tuberculosis can lead to failure to complete the diagnosis and increase dropout rate of smear positive pulmonary tuberculosis (PTB) cases. This implies such dropout patients without completing diagnosis are critical as infected individuals remain untreated in the community, providing more opportunities for transmission of the disease and adversely affecting the epidemic. The aim of this research is to determine the level of smear positive PTB diagnosis dropout rate of spot-morning-spot sputum microscopy diagnosis method in public health facilities, in Addis Ababa, Ethiopia. Methods. Retrospective review of patient documents in 13 public health facilities’ TB laboratory in Addis Ababa was conducted from October 2011 to March 2016. Data was computerized using Epi-info software and analysed using SPSS version 20.0 software. Descriptive numerical summaries were used to present the findings. Association between the dropout rate and demographic variables was assessed by Chi-square (X2). Bivariate model using Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated. P-Value less than 0.05 was taken as statistically significant. Results. Of 41,884 presumptive TB patients registered during the 53 months for laboratory investigation, 5.9% were positive for the first spot sputum smear microscopy. Among these positive cases, 142 (5.8%) and 298 (12.1%) did not come back to the laboratory to submitted early morning and second spot sputum specimens, respectively. The diagnostic dropout for morning sputum specimen in hospitals was 5.6% (58/1039) and in health centres was 5.9% (84/1424). However, higher proportion of dropout for second spot sputum specimen in hospitals was 16.4% (170/1039), compared to the health centres, 8.9% (128/1424). Diagnostic dropout of sputum smear microscopy had no significant association with sociodemographic variable (P value >0.05), while it had significant association with facility type (P value <0.05). Conclusion. In this study smear positive pulmonary tuberculosis diagnostic dropout rate was high compared to WHO reported for the new strategy shift implying the importance of shifting to same-day approach. Hence, shifting from conventional to same day is crucial to minimize the TB diagnostic dropout rate in the study area and other similar settings. Further research is needed/recommended in the local setting to compare the yield and dropout rates between same-day and conventional sputum smear microscopy approach.

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Sputum smear-positive pulmonary tuberculosis: Is sputum smear examination required to discontinue airborne precautions?

Médecine et Maladies Infectieuses ◽

10.1016/j.medmal.2015.09.001 ◽

2015 ◽

Vol 45 (10) ◽

pp. 411-413

Author(s):

X. Argemi ◽

M. Albrecht ◽

Y. Hansmann ◽

B. Jaulhac ◽

C. Koebel ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Sputum Smear ◽

Smear Examination ◽

Smear Positive Pulmonary Tuberculosis ◽

Sputum Smear Examination

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Treatment outcome of smear-positive pulmonary tuberculosis patients in Tigray Region, Northern Ethiopia

BMC Public Health ◽

10.1186/1471-2458-12-537 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 46

Author(s):

Gebretsadik Berhe ◽

Fikre Enquselassie ◽

Abraham Aseffa

Keyword(s):

Treatment Outcome ◽

Pulmonary Tuberculosis ◽

Northern Ethiopia ◽

Tuberculosis Patients ◽

Tigray Region ◽

Smear Positive Pulmonary Tuberculosis

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Impact of diabetes on clinical presentation and treatment outcome of pulmonary tuberculosis in Beijing

Epidemiology and Infection ◽

10.1017/s095026881400079x ◽

2014 ◽

Vol 143 (1) ◽

pp. 150-156 ◽

Cited By ~ 17

Author(s):

C. HONGGUANG ◽

L. MIN ◽

J. SHIWEN ◽

G. FANGHUI ◽

H. SHAOPING ◽

...

Keyword(s):

Diabetes Mellitus ◽

Treatment Outcome ◽

Pulmonary Tuberculosis ◽

Odds Ratio ◽

Clinical Presentation ◽

Underlying Mechanism ◽

Urban Setting ◽

Sputum Smear ◽

Positive Sputum Smear ◽

The Impact

SUMMARYDiabetes mellitus (DM) is currently known to be one of the risk factors for pulmonary tuberculosis (PTB) and the proportion of DM in PTB is rising along with the increased prevalence of DM in countries with high PTB burden. This study was designed to explore the impact of DM on clinical presentation and treatment outcome of PTB in China. In an urban setting in Beijing, 1126 PTB patients, 30·6% with positive sputum smear, registered in two PTB dispensaries from January 2010 to December 2011 were screened for DM and were followed up prospectively during PTB treatment. DM was observed in 16·2% of patients with PTB. PTB with DM appeared to be associated with older age and a higher proportion of re-treatment. On presentation, DM was associated with more severe PTB signs with higher proportions of smear positivity [odds ratio (OR) 2·533, 95% confidence interval (CI) 1·779–3·606], cavity (OR 2·253, 95% CI 1·549–3·276) and more symptoms (OR 1·779, 95% CI 1·176–2·690). DM was also associated with non-TB deaths (OR 5·580, 95% CI 2·182–14·270, P < 0·001) and treatment failure (OR 6·696, 95% CI 2·019–22·200, P = 0·002). In Beijing, the findings of this study underlined the need to perform early bi-directional screening programmes and explore the underlying mechanism for different treatment outcomes for PTB with DM.

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Relapse after short-course chemotherapy of patients with sputum smear-positive pulmonary tuberculosis under routine conditions with additional information on side effects and contact tracing

Tubercle and Lung Disease ◽

10.1016/s0962-8479(96)90115-x ◽

1996 ◽

Vol 77 (5) ◽

pp. 425-428 ◽

Cited By ~ 2

Author(s):

F.D.Garcia Martinez ◽

H.Mayorga Hernandez

Keyword(s):

Side Effects ◽

Pulmonary Tuberculosis ◽

Contact Tracing ◽

Sputum Smear ◽

Additional Information ◽

Short Course ◽

Smear Positive Pulmonary Tuberculosis ◽

Short Course Chemotherapy

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Randomized Dose-Ranging Study of the 14-Day Early Bactericidal Activity of Bedaquiline (TMC207) in Patients with Sputum Microscopy Smear-Positive Pulmonary Tuberculosis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02243-12 ◽

2013 ◽

Vol 57 (5) ◽

pp. 2199-2203 ◽

Cited By ~ 45

Author(s):

Andreas H. Diacon ◽

Rodney Dawson ◽

Florian Von Groote-Bidlingmaier ◽

Gregory Symons ◽

Amour Venter ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Bactericidal Activity ◽

Linear Trend ◽

Sputum Smear ◽

Sputum Microscopy ◽

Blinded Study ◽

Smear Positive Pulmonary Tuberculosis ◽

Dose Ranging ◽

Safety Considerations ◽

Double Blinded

ABSTRACTBedaquiline is a new antituberculosis agent targeting ATP synthase. This randomized, double-blinded study enrolling 68 sputum smear-positive pulmonary tuberculosis patients evaluated the 14-day early bactericidal activity of daily doses of 100 mg, 200 mg, 300 mg, and 400 mg bedaquiline, preceded by loading doses of 200 mg, 400 mg, 500 mg, and 700 mg, respectively, on the first treatment day and 100 mg, 300 mg, 400 mg, and 500 mg on the second treatment day. All groups showed activity with a mean (standard deviation) daily fall in log10CFU over 14 days of 0.040 (0.068), 0.056 (0.051), 0.077 (0.064), and 0.104 (0.077) in the 100-mg, 200-mg, 300-mg, and 400-mg groups, respectively. The linear trend for dose was significant (P= 0.001), and activity in the 400-mg dose group was greater than that in the 100-mg group (P= 0.014). All of the bedaquiline groups showed significant bactericidal activity that was continued to the end of the 14-day evaluation period. The finding of a linear trend for dose suggests that the highest dose compatible with safety considerations should be taken forward to longer-term clinical studies.

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