scholarly journals Sputum Smears Conversion in Daily Versus Intermittent Treatment Regimen in New Sputum Smear Positive Pulmonary Tuberculosis Patients - A Retrospective Study

2021 ◽  
Vol 10 (42) ◽  
pp. 3617-3622
Author(s):  
Dhondiba Haribhau Bhise
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Regimen ◽  
Sputum Smear ◽  
Patient Death ◽  
Continuation Phase ◽  
Intensive Phase ◽  
Tuberculosis Patients ◽  
National Tuberculosis ◽  
Smear Positive Pulmonary Tuberculosis ◽  
Negative Conversion

BACKGROUND Sputum smear conversion is the negative conversion of the sputum smear at the end of the second month of treatment regimen under the National Tuberculosis Elimination Program (NTEP). When the acid-fast bacillus (AFB) smear comes negative at the end of an intensive phase, the treatment regimen can shift to the continuation phase that indicates bacillary load is a minimum. Although some authors consider the conversion of cultures when the AFB smear is negative, two potent drugs in the continuation phase are sufficient to kill the remaining bacilli. The drug that can kill bacteria in the first 2 days of treatment is called early bactericidal activity (EBA). This can be assessed by the percentage of negative conversion of cultures at the end of the intensive phase of the treatment regimen. EBA is very essential because it reduces the transmission in the community and chances of patient death. When the purpose is to kill as many bacilli as possible in the first few days and weeks of treatment, it is very important to include bactericidal drugs in the treatment regimen so that it reduces the chances of patient death and infectiousness and the negative conversion of the cultures after 2-month treatment regimen is an indication of the bactericidal capacity of the drug. The purpose of this study was to compare sputum smear conversion in daily versus intermittent treatment regimens in diagnosed cases of new sputum smear-positive pulmonary tuberculosis patients. METHODS This retrospective observational study was carried out in the Department of Respiratory medicine and nodal drug resistance tuberculosis centre (DR-TB) at the Government medical college and hospital, Akola. In this study, a total of 120 new patients were taken. 60 patients were given daily and intermittent regimens respectively under NTEP. RESULTS Out of 120 patients, 56 (93.33 %) patients in intermittent and 53 (88.33 %) patients in daily regimen were sputum smear-negative at the end of 2nd month (intensive phase) and at the end of 6th month (continuation phase). 1 patient (1.6 %) remained sputum smear-positive after the intensive phase. That patient was given 1 month of extension of anti-tuberculosis treatment (AKT) in the intensive phase and the patient became sputum negative after 1 month of extension. CONCLUSIONS It was concluded in this study, daily regimens and intermittent regimens were equally effective in negative conversion of the sputum smear at the end of the intensive phase and the end of the continuation phase. Negative conversion of the sputum smear is quite important because the bacillary load will be so low at the end of 2nd month that reduces the chances of patient death and transmission in the community. KEY WORDS Pulmonary Tuberculosis (PTB), Drug-Resistant TB (DR-TB), National Tuberculosis Programme (NTP), Revised National TB Control Program (RNTCP), Intensive Phase (IP), continuation Phase (CP), National Tuberculosis Elimination Program (NTEP).

scholarly journals Determinants of sputum smear nonconversion in smear-positive pulmonary tuberculosis patients in Suriname, 2010 – 2015

2019 ◽  
Vol 43 ◽  
pp. 1 ◽  
Author(s):  
Eric Commiesie ◽  
Deborah Stijnberg ◽  
Diana Marín ◽  
Freddy Perez ◽  
Mauro Sanchez
Keyword(s):  
Risk Factors ◽  
Pulmonary Tuberculosis ◽  
Age Groups ◽  
Multivariate Logistic Regression Analysis ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
National Tuberculosis ◽  
Smear Positive Pulmonary Tuberculosis ◽  
Potential Risk Factors ◽  
Control Study

Objective. To identify factors associated with sputum smear nonconversion in patients with pulmonary tuberculosis (PTB) in Suriname. Methods. A case-control study was conducted using routinely-collected surveillance data of PTB cases reported in January 2010 – December 2015 and recorded in the database of the National Tuberculosis Program of Suriname. Cases were smear-positive PTB patients whose sputum results were negative 2 months after treatment initiation. Controls were the smear-positive PTB patients whose sputum results were negative in the same timeframe. Multivariate logistic regression analysis was used to examine associations between potential risk factors and smear conversion. Results. The two age groups ≥ 35 years (35 – 54 years, AOR: 2.7, 95%CI: 1.2 – 6.1; and 55+ years, AOR: 2.5, 95%CI: 1.1 – 5.9) and high bacillary load at baseline (AOR 2.34, 95%CI: 1.2 – 4.8) were significantly associated with delayed smear conversion. Conclusion. The National TB program of Suriname should develop strategies to address patients at higher risk for delayed smear conversion to prevent further spreading and unfavorable treatment outcomes. To better inform decision-making and future studies, the NTP should expand its data collection to include all risk factors for delayed smear conversion.

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

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
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.

scholarly journals Trends in sputum smear conversion among smear-positive pulmo-nary tuberculosis patients

2015 ◽  
Vol 4 (1) ◽  
pp. 24-33
Author(s):  
SEK Acquah ◽  
L Quaye ◽  
W Walana ◽  
EK Vicar ◽  
YN Osei ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Significant Proportion ◽  
Response To Therapy ◽  
Sputum Smear ◽  
Patient Response ◽  
Important Indicator ◽  
Intensive Phase ◽  
Tuberculosis Patients ◽  
Conversion Rates

Sputum smear conversion during pulmonary tuberculosis treatment is an important indicator of patient response to therapy and as such determines the direction of TB patient care. This retro-spective review assessed the trends in sputum smear evaluation and conversion rates among follow up pulmonary tuberculosis patients presenting to the Tamale Teaching Hospital from January 2004 to December 2012. A total of 8,238 sputum smear cases comprising of 6,892 (83.7%) diagnoses and 1,346 (16.3%) follow-up cases were recorded. The 1,346 follow-up cases comprised of 57.8% (778/1346) males and 42.2% (568/1346) females. The percentage proportion of follow up cases that had their month of follow up, residential addresses, ages and smear results reported are 93.8% (1262/1346), 95.2% (1281/1346), 98.2% (1322/1346) and 97.8% (1309/1346) respectively. The cumula-tive median age was 43years (IQR: 30 to 55years) with the minimum and maximum ages being 14 and 80 years recorded in 2008 and 2012 respectively. Thirty eight percent (511/1,346) of follow-up cases were from the intensive phase (month 2) evaluation period. One hundred and eleven (111) of the follow up cases were smear positive representing a cumulative positivity rate of 8.5% (111/1309). This comprised of 75(67.6 %) males and 36(32.4%) females. Generally males were observed to be significantly more likely to delay smear conversion during treatment (OR = 1.560; p = 0.035, 95% CI=1.032- 2.359) compared to females. The ages of the positive cases ranged from 14 to 75 years with a median age of 45.5 years. The intensive phase (month 2) positivity rate was 8.1% (63/776) representing a conversion rate of 91.9%. Significant proportion (15.4%) of males were smear posi-tive and were more likely to remain positive after two months of therapy compared to their female counterparts (OR = 2, p = 0.02, CI = 0.098 – 1.299). Periodic surveillance of regional sputum smear late/non conversion among PTB patients on treatment would be useful in supporting Tb manage-ment in Ghana.Keywords: Mycobacterium tuberculosis, follow up, microscopy, acid fast bacilli, Ghana

scholarly journals Analysis of treatment outcomes for destructive pulmonary tuberculosis in patients with multiple drug resistance of M. tuberculosis

2020 ◽  
Vol 98 (10) ◽  
pp. 23-27
Author(s):  
Yu. A. Sheyfer ◽  
I. S. Gelberg
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Clinical Cure ◽  
Multiple Drug Resistance ◽  
Group Versus ◽  
Multiple Drug ◽  
Continuation Phase ◽  
Intensive Phase ◽  
Tuberculosis Patients ◽  
Sputum Conversion

The objective of the study: to analyze treatment outcomes in patients with pulmonary destructive MDR tuberculosis who completed the intensive phase of treatment and had healed or persisting cavities.Subjects and methods. Treatment outcomes were retrospectively analyzed in 191 patients suffering from destructive pulmonary MDR tuberculosis who underwent the intensive phase of chemotherapy in in-patient settings in 2009-2012 and 2013-2015 (treated by different regime ns);  in each of those cohorts, groups were formed depending on persistence/healing of destruction (cavities) during the intensive phase of chemotherapy:  (CV-) ‒ the destruction healed, (CV+) – the destruction persisted.Results. In 24 months, treatment was found to be effective only in 19/68 (27.9%) in the (CV+) group versus 31/40 (77.5%) in the (CV-) group, p < 0.05 (cohort 2009-2012); 17/42 (40.5%) versus 29/41 (70.7%), respectively, p < 0.05 (2013-2015 cohort). Within 48 months, treatment outcomes were as follows: clinical cure in the (CV+) group was 38.2% (26/68 people), and in the (CV-) group – 72.7% (29/40 people), p < 0.05 (2009- 2012) and 23/42 (54.7%) and 33/41 (80.5%), respectively, p < 0.05 (2013-2015 cohort).Conclusion. Considering the above, when assessing treatment in the intensive phase of chemotherapy in destructive pulmonary tuberculosis patients, it is necessary to take into account the rate of cavity healing but not being limited to sputum conversion. Patients with persisting cavities should not be transferred to the continuation phase, the surgery or collapse treatment should be considered for such patients.

scholarly journals Treatment outcome in new smear positive pulmonary tuberculosis patients with and without immunosuppression on RNTCP regimen: a comparative observational study

2017 ◽  
Vol 5 (2) ◽  
pp. 384 ◽  
Author(s):  
Radhika Muttath ◽  
Mekkattukkunnel Andrews ◽  
Dinesa Prabhu
Keyword(s):  
Treatment Outcome ◽  
Pulmonary Tuberculosis ◽  
Steroid Therapy ◽  
Group Treatment ◽  
Control Group ◽  
Sputum Smear ◽  
Diabetic Patients ◽  
Hiv Patients ◽  
Tuberculosis Patients ◽  
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.

scholarly journals Effectiveness of a case management model in newly treated smear-positive pulmonary tuberculosis patients

2021 ◽  
Vol 15 (11) ◽  
pp. 1670-1676
Author(s):  
YanLing Li ◽  
Ying Wang ◽  
GaiJing Wang ◽  
YiLin Wang ◽  
YanQing Tian ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Case Management ◽  
Conversion Rate ◽  
Management Mode ◽  
Control Group ◽  
Tuberculosis Patients ◽  
Smear Positive Pulmonary Tuberculosis ◽  
Experimental Group ◽  
Knowledge Attitude And Practice ◽  
Negative Conversion

Introduction: To investigate the effectiveness of the case management mode on the application of smear-positive pulmonary tuberculosis patients. Methodology: This was a randomized control trial. A total of 70 newly diagnosed smear-positive pulmonary tuberculosis patients were recruited and been randomly divided into experimental group and control group, with 35 participants in each group. In the experimental group, patients received the tuberculosis case management mode based on the conventional management mode. In the control group, patients received the routine management mode. We compared the knowledge, attitude, and practice score; sputum-negative conversion rate, effective imaging rate of the two groups at the time of initial admission, discharge, and one month after discharge. Results: The results showed that there was no significant difference in baseline data between the two groups (p > 0.05); at the time of discharge and one month after discharge, the knowledge, belief, behavior, sputum-negative conversion rate, and imaging examination effective rate of the experimental group were higher than those of the control group (p < 0.05). Conclusions: The case management mode can improve the knowledge, attitude, and practice level; sputum-negative conversion rate; and imaging efficiency of newly treated smear-positive pulmonary tuberculosis patients.

scholarly journals Faktor yang berhubungan dengan tidak terkonversinya BTA positif pada pengobatan kasus baru di Semarang

2016 ◽  
Vol 32 (3) ◽  
pp. 77
Author(s):  
Marizan Marizan ◽  
Yodi Mahendradhata ◽  
Trisno Agung Wibowo
Keyword(s):  
Pulmonary Tuberculosis ◽  
Sampling Technique ◽  
Sputum Smear ◽  
Drug Side Effects ◽  
Intensive Phase ◽  
Smear Positive Pulmonary Tuberculosis ◽  
Positive Smear ◽  
And Gender ◽  
The City ◽  
Positive Results

Factors related to non-conversion smear positive among patients with pulmonary tuberculosis in the city of SemarangPurposeThe purpose of this study was to identify factors related to non-conversion of smear positive in treatment of new tuberculosis cases. MethodsThis study used a case control design and sampling by proportional random sampling technique. Samples were patients with smear grade positive pulmonary tuberculosis who were new cases of intensive phase of treatment and have repeated sputum examination. The numbers of samples in this research were 128 sample cases and 128 controls. ResultsThe factors associated with the conversion of smear positive pulmonary tuberculosis treatment of new cases were age, sex, drug side effects, comorbidities and gradation smear results. The three variables that proved to jointly influence the incidence of smear positive conversion in the treatment of new cases of pulmonary tuberculosis were sputum smear results gradation, comorbidities and gender. ConclusionIt is necessary to design an appropriate drug taking supervisor for patients with positive smear positive results with +2 and +3 gradations and patients with comorbidities (HIV, hepatitis, diabetes mellitus).

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