A Study on Delay in Giving the Early Morning Sample and Barriers in Accessing Sputum Smear Microscopy Services at Tertiary Care Hospital

Background: Under revised National tuberculosis control program two sputum samples are to be collected for diagnosis of presumptive pulmonary tuberculosis case. The objective of this study is to find the concordance of both sputum smear microscopy samples at a tertiary care hospital. Methods: Hospital based record was collected from designated microscopy center laboratory register. The data collected were from January 2015 to November 2016. Results: A total of 2117 paired of sputum sample were collected for the year 2015-16 in one of the DMC of a tertiary care hospital. A total of 183 patient (at least one sputum sample) were positive (8.64%) and 1934 were both negative. Among the positive sample concordance for both spot and morning samples were 89% (163/183) and discordance where spot sample positive and morning sample negative was 4.91% (9/183) and where spot sample negative and morning sample positive was 6.01% (11/183). Overall discordance between spot and morning samples were only 0.94% (20/2117). Conclusions: There is a good concordance of two sputum samples. Discordance of two sputum samples were <1% in a tertiary care hospital. One sample may be sufficient for operational purpose for diagnosis of pulmonary Tb. But to have a robust recommendation a RCT will be required to see the extent of discordance by ruling out bias in sputum smear examination.

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Baseline Study of Sputum Microscopy for Diagnosis of Tuberculosis in Western Region of Nepal

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i2.20343 ◽

2018 ◽

Vol 17 (2) ◽

pp. 19-24 ◽

Cited By ~ 1

Author(s):

Amrita Dhakal ◽

Samata Nepal ◽

Alok Atreya ◽

Basista Rijal

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Control Policy ◽

Early Morning ◽

Sputum Smear ◽

Western Region ◽

Care Hospital ◽

Sputum Microscopy ◽

Minimum Age ◽

A Prospective Study

Introduction: Tuberculosis is a major health issue in Nepal. Early detection of tuberculosis is essential to identify the case which limits the transmission of tuberculosis and builds an effective approach of tuberculosis control policy. Therefore, the present study is aimed to assess the case of tuberculosis by sputum smear examination.Methods: A prospective study was conducted in a tertiary care hospital of Western Nepal. Two sputum samples were collected from each suspect – spot specimen on the first day and one early morning specimen on the second day. The standard protocol of Ziehl Neelsen stain was applied to detect the acid fast bacilli.Results: Out of 280 smears from suspected patients, only 30 showed smear positivity (10.7%). Among the total identified positive case of tuberculosis (30/280), the highest rate was observed in the age group of 56-65 years. Males (56.7%) were highly affected by tuberculosis than females (43.3%). The minimum age of the suspects was two years and maximum age was of 105 years with mean age of 53.6 years.Conclusions: It is concluded that prevalence of tuberculosis is high in patients attending tertiary care hospital in Western region of Nepal, which is slightly higher than the annual report of National Tuberculosis Program 2017. Incidence of pulmonary tuberculosis is higher in males as compared to females.

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Comparison between ziehl-neelsen staining and fluorescent staining of sputum samples to detect acid fast bacilli in suspected case of pulmonary tuberculosis at tertiary care hospital, Amreli, Gujarat

Indian Journal of Microbiology Research ◽

10.18231/j.ijmr.2021.061 ◽

2021 ◽

Vol 8 (4) ◽

pp. 302-307

Author(s):

Hetvi Chawda ◽

Chandani Surani ◽

Sanjeev Kumar ◽

Meghana Chauhan ◽

Ashok Kumar Ramanuj ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Tertiary Care ◽

Early Morning ◽

Causative Organism ◽

Sputum Smear ◽

Suspected Case ◽

Care Hospital ◽

Fluorescent Staining ◽

Acid Fast Bacilli ◽

Fluorescent Stain

In India, Tuberculosis (TB) is one of the major community health problems.Pulmonary tuberculosis (PTB) is a respiratory disease. Causative organism for this is acid fast bacilli known as . It is the most ordinary disease affecting the lower socio-economic class in developing countries. Microbiological diagnosis is the heart for the effective treatment of pulmonary TB (PTB). The look forrapid and efficient method has resulted in several staining techniques. Objective of the study was to compare the results of ZN stain (RNTCP) with fluorescent stain by use of microscopy. The study was carried out in Microbiology Department, SMCGH, Amreli. 350 sputum samples (Spot and early morning sample) collected from 175 suspected case of the pulmonary tuberculosis. All 350 samples were processed by ZN stain and Fluorescent stain to detect acid fast bacilli. By use of microscope, the results of the stained smears were given according to RNTCP guideline.Out of 350 sputum smears, 52 (14.85%) and 61 (17.4%) were positive by ZN and FM staining respectively. Males are predominantly affected than females. Majority of the patients were in age above 50 years. Early morning samples were more reliable than spot samples for detection of acid fast bacilli for ZN stain, but not for fluorescent stain.Fluorescent staining with LED microscopy was more efficient than ZN staining for detection of acid fast bacilli from sputum smear.

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Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan

BMC Infectious Diseases ◽

10.1186/s12879-021-06086-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Asifa Karamat ◽

Atiqa Ambreen ◽

Aamira Ishtiaq ◽

Sabira Tahseen ◽

Muhammad Aqeelur Rahman ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Drug Susceptibility Testing ◽

Nucleic Acid Amplification ◽

Clinical Samples ◽

Smear Microscopy ◽

Care Hospital ◽

Clinical Specimens ◽

Tb Treatment ◽

Clinical Records

Abstract Background There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nucleic acid amplification testing for Mycobacterium tuberculosis complex (MTBC) offers improved diagnostic accuracy, compared with smear microscopy, and also assists in differentiating MTBC from other mycobacteria. This study aimed to investigate the prevalence of NTM among patients investigated for TB and describe NTM disease and treatment outcomes at a tertiary care hospital in Pakistan. Methods This is a retrospective study, data on NTM isolates among culture-positive clinical samples over 4 years (2016–19) was retrieved from laboratory records. Information on clinical specimens processed, AFB smear results, and for the AFB positive isolates, results of species identification for MTBC, and for NTM isolates, results of species characterization and drug susceptibility testing was collected. Additional clinical data including patient characteristics, treatment regimens, and outcomes were collected for patients with NTM disease treated at Gulab Devi Hospital, Lahore. Results During the study period, 12,561 clinical specimens were processed for mycobacterial culture and 3673 (29%) were reported positive for AFB. Among these 3482 (95%) were identified as MTBC and 191 (5%) as NTM. Among NTM, 169 (88%) were isolated from pulmonary and 22 (12%) from extrapulmonary specimens. Results of NTM speciation were available for 60 isolates and included 55% (n = 33) M. avium complex and 25% (n = 15) M. abscesses. Among these patients, complete clinical records were retrieved for 12 patients with pulmonary disease including nine infected with M. avium complex and three with M. abscessus. All 12 patients had a history of poor response to standard first-line anti-TB treatment. Ten patients were cured after 18 months of treatment, whereas, one with M. abscessus infection died and another was lost to follow up. Conclusion In TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti-TB treatment and increased morbidity, emphasizing the need for improved diagnosis.

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DIAGNOSTIC PERFORMANCE OF ZIEHL-NEELSEN & CBNAAT TECHNIQUES IN PULMONARY TUBERCULOSIS, A RETROSPECTIVE ANALYSIS AT TERTIARY CARE HOSPITAL IN JHALAWAR, RAJASTHAN.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i1.1633 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Shilpi Hora ◽

Neeraj Raman ◽

Mukesh Kumar ◽

Needa Saneef

Keyword(s):

Pulmonary Tuberculosis ◽

Tertiary Care Hospital ◽

Point Of Care ◽

Tertiary Care ◽

Nucleic Acid Amplification ◽

Smear Microscopy ◽

Care Hospital ◽

Age Group ◽

Hands On ◽

High Incidence

Introduction: Tuberculosis (TB) remains a leading cause of death among infectious diseases worldwide. The advent of the CBNAAT was a revolution in the diagnosis of tuberculosis, especially with high incidence and resource poor regions. It can be used close to the point of care by operators with minimal technical expertise, enabling diagnosis of TB and rifampicin Resistance (RIF) concurrently using unprocessed clinical specimens, in less than 2h. Aim: To evaluate the diagnostic performances of Ziehl-Neelsen & CBNAAT techniques in detection of Pulmonary Tuberculosis. Materials and Methods: We retrospectively reviewed the 2414 sputum samples of suspected pulmonary TB. Sputum samples were subjected for ZN staining and CBNAAT.RIF resistance was detected by CBNAAT. Results: Out of 2414 samples, 751 sputum samples were positive by smear microscopy. 1127 Samples were confirmed positive by CBNAAT examination. Majority of cases, 43.57% were in 21-40 yrs age group.24.40% were females and 75.59% were males. Sensitivity of CBNAAT was 100% for sputum positive cases and sensitivity was 22.6% for sputum negative cases. Overall RIF resistance was detected in 49 (4.4%) cases in present study. Conclusion: CBNAAT provide sensitive detection of tuberculosis and rifampicin resistance directly from untreated sputum in less than 2 hours with minimal hands-on time. Keywords: Cartridge-based nucleic acid amplification tests (CBNAAT), Rifampicin(RIF)

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Improved Diagnosis of Pulmonary Tuberculosis using Bleach (Sodium hypochlorite) Concentration Technique at Tertiary Care Hospital

Nepal Journal of Health Sciences ◽

10.3126/njhs.v1i2.42371 ◽

2021 ◽

Vol 1 (2) ◽

pp. 15-22

Author(s):

Saroj Kumar Thakur ◽

Vishvesh Prakashchandra Bansal ◽

Jyotsna Mishra ◽

M.P. Bansal ◽

Iswari Sapkota ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Sodium Hypochlorite ◽

Direct Method ◽

Tertiary Care ◽

Sputum Smear ◽

Smear Microscopy ◽

Care Hospital ◽

Case Detection ◽

Acid Fast Bacilli ◽

Concentration Method

Introduction: In the Revised National Tuberculosis Control Program (RNTCP), microscopic examination of sputum for acid-fast bacilli (AFB) is currently the backbone for the diagnosis of pulmonary tuberculosis. Studies have shown liquefaction and concentration of sputum by 5% sodium hypochlorite is useful in providing increased sensitivity and safety for the handling of specimens. Objective: To assess the utility of the 5% Sodium hypochlorite concentration method in increasing the sensitivity of smear microscopy for detection of AFB for diagnosis of pulmonary tuberculosis. Methods: The study included a total of 1000 sputum samples from 500 patients with suspected pulmonary tuberculosis. Direct smears were prepared from the sputum samples as per RNTCP guidelines. The remaining sputum was used for bleach concentration and smears prepared from the concentrated material. Both smears were stained by Ziehl-Neelsen staining and screened for acid-fast bacilli and graded according to the RNTCP guidelines. Results: A total of 158 samples (15.8%) from 89 patients were positive by a routine direct method whereas by concentration method 236 samples (23.6%) from 143 patients were found positive diagnosing additional 54 patients. The gain in sputum smear positivity of 7.8% over the routine method is highly significant (p=0.0000, χ2= 270) with a 10.8% increase in case detection. Conclusions: Improvement in the sensitivity of smears microscopy will be useful in case detection of tuberculosis especially in resource-poor countries. The increased positivity of microscopy by bleach method indicates that would prove useful if included in the RNTCP to improve case detection. Keywords: Concentration; smear positivity; sodium hypochlorite; tuberculosis.

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Longitudinal study to assess socio-demographic profile and treatment outcome of new sputum smear positive cases at designated microscopy centre of tertiary care hospital

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20185258 ◽

2018 ◽

Vol 6 (1) ◽

pp. 281

Author(s):

G. R. Vishwanath ◽

Sandeep Dattatray Babar ◽

J. D. Naik ◽

Girish Kamble

Keyword(s):

Treatment Outcome ◽

Longitudinal Study ◽

Nuclear Family ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Control Program ◽

Sputum Smear ◽

Treatment Schedule ◽

Care Hospital ◽

Age Group

Background: Tuberculosis (TB) remains one of the world’s deadliest communicable diseases. In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease, 360 000 of whom were HIV-positive. Of the estimated 9 million people who developed TB in 2013, more than half (56%) were in the South-East Asia and Western Pacific Regions and India and China alone accounted for 24% and 11% of total cases, respectively. India’s TB Control Program is on track as far as reduction in disease burden is concerned there was 50% reduction in TB mortality rate by 2013 as compared to 1990 level. Tuberculosis prevalence per lakh population reduced from 465 in year 1990 to 211 in 2013. But still, in India there is high burden of Tuberculosis cases and high mortality in the current situation.Methods: Descriptive Longitudinal study was conducted from 1st January 2015 to 31st December 2016 at designated microscopy centre (DMC) in tertiary care hospital of Government Medical Miraj.Results: Maximum of TB cases 47 (30.71%) were from >30-45 age group and 72 (47.05%) cases belongs nuclear family. 126 (82.35%) cases had completed their treatment schedule for 6/7 months were labelled ‘cured’ at the end of study, while among 27 (17.65%) cases 17 (11.11%) ‘Died’ during treatment schedule, 9 (5.88%) cases became ‘defaulters’ and 1 (0.65%) case was ‘failure’.Conclusions: In the present study, Maximum cases were from >30-45 yrs age group and proportions of males were more as compare to females. Hindus was predominantly more in number among all religions and number of cases coming from rural area was more. The association between gender and treatment outcome of study cases was found statistically significant.

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