Concordance of two sputum smear microscopy for diagnosis of presumptive pulmonary tuberculosis in a tertiary care hospital

Star Pala; Kyrshan G. Lynrah

doi:10.18203/2394-6040.ijcmph20173152

Authors

Star Pala Department of Community Medicine, NEIGRIHMS, Shillong, India
Kyrshan G. Lynrah Department of General Medicine, NEIGRIHMS, Shillong, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20173152

Keywords:

Sputum samples, Pulmonary tuberculosis, Concordance of spot and morning samples

Abstract

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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Author Biography

Star Pala, Department of Community Medicine, NEIGRIHMS, Shillong, India

Associate Professor of Community Medicine

NEIGRIHMS, SHillong

References

World Health Organization. World Global TB Reports, 2016

Central TB Division, Directorate General of Health Services, MoHFW, GOI. India Tuberculosis Report; 2017.

World Health Organization. Framework for effective tuberculosis control. World Health Organization document 1994; WHO/TB/94.179:1-7.

World Health Organization. International Union Against Tuberculosis and Lung Disease, Royal Netherlands Tuberculosis Association. Revised international definitions in tuberculosis control. Int J Tuberc Lung Dis. 2001;5:213-5.

Reduction of number of smears for the diagnosis of pulmonary TB, 2007. TB diagnostics and laboratory strengthening - WHO policy.

Central TB Division, Directorate General of Health Services. Diagnosis of Smear Positive Pulmonary TB—New Guidelines, effective from 1 April 2009. Ministry of Health and Family Welfare, GOI; 2009. Available at: http://tbcindia.nic.in/pdfs Accessed on 4 April 2017.

Frieden T. Toman’s Tuberculosis Case Detection, treatment and monitoring- questions and answers. WHO Geneva, 2004, 2nd Edition.

Mase SR, Ramsay A, Ng V, Henry M, Hopewell PC, Cunningham J, et al. Yield of serial sputum specimen examination in the diagnosis of pulmonary tuberculosis: a systematic review. Int J Tuberc Lung Dis. 2007;11(5):485-95.

Central Tb Division, MohFW, GOI. Technical and Operational Guidelines for TB Control in India 2016. Available at: http://tbcindia.gov.in/ showfile.php?lid=3216 Accessed on 4 April 2017.

Squire SB, Belaye AK, Kashoti A, Salaniponi FM, Mundy CJ, Theobald S, et al. 'Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them? Int J Tuberc Lung Dis. 2005;9(1):25-31.

Cambanis A, Yassin MA, Ramsay A, Squire SB, Arbide I, Cuevas LE. A one-day method for the diagnosis of pulmonary tuberculosis in rural Ethiopia. Int J Tuberc Lung Dis. 2006;10(2):230-2.

Davis JL, Cattamanchi A, Cuevas LE, Hopewell PC, Steingart KR. Diagnostic accuracy of same-day microscopy versus standard microscopy for pulmonary tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(2):147-54.

Chandra TJ, Selvaraj R, Sharma YV. Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: Ziehl-Neelsen versus fluorescent staining. J Family Med Prim Care. 2015;4(4):525-8.

Chandra TJ, Selvaraj R, Sharma YV. Same-day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: direct vs. concentrated smear. Int J Tuberc Lung Dis. 2016;20(2):247-51.

Chandra TJ, Raj RS, Sharma YV. Same day sputum smear microscopy approach with modified ZN staining for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry. Indian J Med Microbiol. 2014;32(2):153-6.

Chandra TJ. Same day sputum smear microscopy approach for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry. Indian J Tuberc. 2012;59(3):141-4.

Juyal D, Thaledi S. Same day sputum microscopy: Optimizing the diagnosis of pulmonary tuberculosis. OA Case Reports. 2014;3(3):25.

Nayak P, Kumar AM, Claassens M, Enarson DA, Satyanarayana S, Kundu D, et al. Comparing same day sputum microscopy with conventional sputum microscopy for the diagnosis of tuberculosis --Chhattisgarh, India. PLoS One. 2013;8(9):e74964.

Deka DJ, Choudhury B, Talukdar P, Lo TQ, Das B, Nair SA, et al. What a difference a day makes: same-day vs. 2-day sputum smear microscopy for diagnosing tuberculosis. Public Health Action. 2016;6(4):232-6.

Ssengooba W, Kateete DP, Wajja A, Bugumirwa E, Mboowa G, Namaganda C, et al. An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda. Tuberculosis Research and Treatment. 2012(2012):970203.

Nayak P, Kumar AM, Agrawal TK, Chandraker S, Nair SA. Same-day light-emitting diode fluore-scence microscopy for the diagnosis of tuberculosis in Chhattisgarh, India. Int J Tuberc Lung Dis. 2014;18(6):666-70.

Myneedu VP, Verma AK, Sharma PP, Behera D. A pilot study of same day sputum smear examination, its feasibility and usefulness in diagnosis of pulmonary TB. Indian J Tuberc. 2011;58(4):160-7.

Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, GOI New Delhi 2005. Guidelines for Quality Assurance of smear microscopy for diagnosing tuberculosis.

Patel MM, Patel AN, Sisodia JA, Patel KR, Shringarpure K. Spot and early morning sputum report study for diagnosis of pulmonary tuberculosis at DMC of medical college Vadodara, Gujarat: a retrospective analysis. Int J Cur Res Rev. 2014;6(10):45-50.

Central TB Division Directorate General of Health Services Ministry of Health and Family Welfare, GOI, Manual for Sputum Smear Fluorescence Microscopy. New Delhi, 2011.

Measurement error: assessment and implications. In: Betty R. Kirkwood and Jonathan A.C. Sterne. Essential Medical Statistics. 2nd ed. Massachusetts, USA: Blackwell Sciences; 2003: 429-446.