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Free Content Two vs. three sputum samples for microscopic detection of tuberculosis in a high HIV prevalence population

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SETTING: A busy urban hospital in Cameroon.

OBJECTIVES: To compare the yield in bacteriologically proven tuberculosis (TB) cases examining two morning vs. three spot-morning-spot sputum specimens (MM vs. SMS) by direct microscopy for acid-fast bacilli (AFB).

DESIGN: Repeated temporal cross-over between MM and SMS sampling for successive TB suspects, using culture as gold standard.

RESULTS: A total of 799 suspects were screened using the MM strategy, identifying 223 smear-positives, and 808 suspects with the SMS strategy, yielding 236 smear-positives. Of the MM, 256 were culture-positive, of whom 195 (76%) were smear-positive. For SMS, these figures were respectively 281 and 206 (73%), a non-significant difference. The MM and SMS strategies also detected respectively 28 and 30 smear-positive cases not confirmed by culture. No cases were lost to treatment with either strategy.

CONCLUSIONS: In this population with a high prevalence of human immunodeficiency virus (HIV) with late case presentation, smear microscopy of two morning specimens detected at least as many positive cases as the classical strategy, and no cases were lost before treatment. Two specimens for initial TB suspect screening can thus be recommended, also without excessive workload. Comparative studies in populations presenting with paucibacillary sputum are needed to determine the equivalent quality and yield of an alternative strategy with two spot specimens at consultation.
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Keywords: Ziehl-Neelsen; microscopy; sputum collection strategy; tuberculosis; yield

Document Type: Regular Paper

Affiliations: 1: German Technical Cooperation, Douala, Cameroon 2: Laboratori Clinic l'Hospitalet, Institut Catala Salut, Barcelona, Spain 3: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium 4: National Tuberculosis Control Programme, Yaounde, Cameroon 5: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium; and International Union Against Tuberculosis and Lung Disease, Paris, France

Publication date: 2009-07-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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