Yield of serial sputum specimen examinations in the diagnosis of pulmonary tuberculosis: a systematic review [Review Article]
Current international tuberculosis (TB) guidelines recommend the microscopic examination of three sputum specimens for acid-fast bacilli in the evaluation of persons suspected of having pulmonary TB. We conducted a systematic review of studies that quantified the diagnostic yield of each of three sputum specimens. By searching multiple databases and sources, we identified a total of 37 eligible studies. The incremental yield in smear-positive results (in studies using all smear-positive cases as the denominator) and the increase in sensitivity (in studies that used all culture-positive cases as the denominator) of the third specimen were the main outcomes of interest. Although heterogeneity in study methods and results presented challenges for data synthesis, subgroup analyses suggest that the average incremental yield and/or the increase in sensitivity of examining a third specimen ranged between 2% and 5%. Reducing the recommended number of specimens examined from three to two (particularly to two specimens collected on the same day) could benefit TB control programs, and potentially increase case detection for several reasons. A number of operational research issues need to be addressed. Studies examining the most effective and efficient means to utilize current technologies for microscopic examination of sputum would be most useful if they followed an internationally coordinated and standardized approach, both to strengthen the country-specific evidence base and to permit comparison among studies.
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serial sputum specimens;
Document Type: Review Article
United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
Albany Medical College, Albany, New York, USA
County of Sacramento Department of Health and Human Services, Sacramento, California, USA
WHO Tuberculosis Laboratory Consultants Group, Schoemberg, Germany
Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
Stop TB Department, WHO, Geneva, Switzerland
Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada
Publication date: 01 May 2007
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