Predictors of time to sputum culture conversion in multi-drug-resistant tuberculosis and extensively drug-resistant tuberculosis in patients at Tshepong-Klerksdorp Hospital

Setting: Klerksdorp-Tshepong Hospital Complex MDR-TB Unit, North-West Province, South Africa.Background: To determine the time to sputum culture conversion (TTSCC) and factors predictive of TTSCC in patients with multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in the North-West Province.Methods: A retrospective cohort study, abstracting patient demographic and clinical data, laboratory results, dates of sputum testing and sputum culture conversion results, from medical records of 526 MDR-TB and 47 XDR-TB patients started on TB treatment between 01 January 2012 and 31 December 2014. Predictors of TTSCC were determined by Cox proportional hazards regression.Results: The median age was 38 years (interquartile range 31­47) with 64% being male. Overall, 79% (449) were Human Immunodeficiency Virus (HIV)-infected. The median TTSCC was 56.5 days and 162.5 days for MDR-TB and XDR-TB patients, respectively. In the multivariate analysis, age [hazard ratio (HR): 0.89, 95% confidence interval (CI): 0.96­0.99], being underweight (HR: 0.631.61, 95% CI: 0.451.03­0.882.51), Acid Fast Bacilli (AFB) positivity (HR: 0.72, 95% CI: 0.51­1.01) and having XDR-TB (HR: 0.36. 95% CI: 0.19­0.69) were predictive of longer TTSCC.Conclusion: Predictors of TTSC allow for MDR-TB- and XDR-TB-diagnosed patients to be identified early for effective management. Those with risk factors for delayed sputum culture conversion which are being underweight and having XDR-TB should be monitored carefully during treatment so that they can achieve sputum culture conversion early

Sputum concentration improves diagnosis of pulmonary tuberculosis cases in children at a tertiary care institution in Rwanda

Introduction: A great concern exists about the emergence of antibiotic resistant organisms. The goal of this study is to delineate antibiotic sensitivity patterns at King Faisal Hospital. Methods: A three years study; from Jan 2009 to Dec 2011 was conducted in the Microbiology unit; department of Laboratory; King Faisal hospital; Rwanda. All the specimens and antibiotic sensitivity were processed according to the standard guidelines. Microorganisms and their sensitivity data were reviewed and compiled by using hospital information system. Results: Over the 3-year period; several Enterobacteriaceae pathogens declined in susceptibility to various antimicrobial agents. A total of 2153 Enterobacteriaceae were isolated. Most common isolate was Escherichia coli check for this species in other resources (1413) followed by Klebsiella check for this species in other resources species (550); Enterobacter check for this species in other resources species (110); Proteus check for this species in other resources species (165); Citrobacter check for this species in other resources Species (79); Shigella check for this species in other resources species (110) and other species. Most notable were the decreased sensitivities to cefuroxime: E. coli (84 to 72); Klebsiella (78 to 33); Enterobacter (50 to 41) Proteus(67 to 59) and Shigella to ciprofloxacin (100 to 96). And also decreased sensitivities to Imipenem: E. coli (100 to 98) and Klebsiella species (100 to 94). Conclusion: These decreased antibiotic sensitivities reflect increased bacterial selection pressure as a result of widespread antibiotic use. A combined approach involving infection-control specialists; infectious disease physicians; and hospital administrators is necessary to address this increasingly difficult problem

Methods of sputum decontamination with emphasis on local tuberculosis laboratories

One of the major goals for the global control of tuberculosis (TB) in humans is the laboratory diagnosis of Mycobacterium tuberculosis the causative agent of TB. This organism is present in sputum specimens which are often contaminated by other fast growing microflora. Therefore; the use of rapid and effective diagnostic methods for optimal detection of Mycobacterium tuberculosis is required through different decontamination methods. This review considers some of the decontamination methods that have been described for the recovery of M. tuberculosis based on published print and electronic articles. Some of these methods have limitations which may make them unsuitable for use in most local laboratories in the developing world; and these include unavailability of essential reagents and materials; cost of acquiring equipment; lack of skilled personnel and undue delay in the time of processing samples. Despite these challenges; there are some methods that have potentials of being adapted for use in clinical mycobacteriology laboratories in developing countries particularly Nigeria. With the correct laboratory logistics put in place; the simplified concentration; Kudoh-Kudoh; and modified Petroff methods may go a long way in achieving effective sputum decontaminations under local setting. The potentials and challenges of using other decontamination methods are discussed

Validation of a Rapid Tuberculosis PCR Assay for Detection of MDR-TB Patients in Gauteng; South Africa

Nucleic acid amplification tests offer shorter turnaround times for diagnosis of tuberculosis (TB) and drug resistance of isolates compared to conventional culture methods. The rapid molecular-based multidrug-resistant (MDR)-TB assay; GenoTyper MTBDRplus (Hain Lifescience) was evaluated in Gauteng; South Africa; as a pilot investigation to assess its performance for detection of MDR-TB in patients who were at high risk of drug-resistant TB. A total of 945 sputum specimens sequentially received within a period of six weeks from seven hospitals were assessed by MTBDRplus and compared to liquid culture drug susceptibility tests (DST) using the MGIT 960 system (BD Diagnostic Systems) as the `gold standard'. Of the 945 specimens processed; 731 had interpretable results from both tests and therefore were included in the analysis. The overall sensitivities of the MTBDRplus in detecting individual resistance to rifampicin (RMP) and isoniazid (INH); as well as MDR were 95.0; 93.4and 100; respectively. The specificities were 99.7for RMP; and 100for INH and MDR. The Genotyper MTBDRplus assay showed excellent concordance with the conventional `gold standard' MGIT DST; and it detected all the MDR-TB cases analysed

Studies on the distribution of clinically diagnosed pulmonary tuberculosis in Ebonyi State, Nigeria

A study was conducted between January; 2005 to December; 2006 to ascertain the prevalence of pulmonary tuberculosis among patients who attended chest clinics in some randomly selected hospitals; Clinics and Health Centers in Ebonyi State; Nigeria. Investigations were carried out using the two popular diagnostic criteria for pulmonary tuberculosis namely the specific Ziehl Neelsen (ZN) methods and chest X-ray. A total of 962 patients with clinical signs and symptoms of tuberculosis were studied. Out of this figure; 559 (58.1) had pulmonary tuberculosis with 1:1 male/female ratio. There was no significant difference between ZN sputum smear positive and chest x-ray in the diagnosis of pulmonary tuberculosis in the studied population at 95confidence level. The possible reasons for the high prevalence of pulmonary tuberculosis may be attributed to increase in the incidence of HIV/AIDS; high rate of poverty; emergence of drug-resistant strains of Mycobacteria and to a lesser extent; smoking and diabetes

Quantitative sputum bacillary load during rifampin-containing short course chemotherapy in human immunodeficiency virus-infected and non-infected adults with pulmonary tuberculosis

Setting: National Tuberculosis (TB) Treatment Centre; Mulago Hospital and Joint Clinical Research Centre; Kampala; Uganda. Objective: To compare the quantitative sputum bacillary load between TB patients infected with the human immunodeficiency virus (HIV) and those non-infected; during treatment with standard short course chemotherapy (SCC). Design: To comapre clinical characteristics and quantitative sputum bacillary load as measured by quantitative acid-fast bacilli (AFB) smears; colony forming unit (cfu) assay and time until positive culture in the BACTEC radiometric liquid system between 14 HIV-infected and 22 non-HIV-Infected adults with initial episodes of smear-positive polmunary TB at baseline and during treatment with standard four-drug SCC. Results: Other than cavitation (P=0.042) and adenopathy (P=0.03); which were more common among non-HIV-infected patients; respectively; there were no significant differences in baseline demographics; clinical; radiological and laboratory characteristics between the groups. Mean pretreatment sputum bacillary burden (6.5+/-0.51 log 10 AFB/ml; 5.91+/-0.91 log 10 cfu/ml and 1.8+/-1.7 days until positive BACTEC culture for HIV-infected patients and 6.32+/-0.85 log 10 AFB/ml; 5.58+/-0.68 log 10 cfu/ml and 1+/-1.2 days until positive BACTEC culture for non-HIV-infected patients) were comparable between HIV-infected and non-HIV-infected patients. Clinical bacteriological responses to standard SCC and treatment outcome did not differ between the groups. Conclusion: Quantitative sputum bacillary load at baseline and during SCC did not differ significantly between HIV-infected and non-HIV-Infected adults with initial episodes of smear - positive TB

Spontaneous sputum examination for early diagnosis of pneumocystis carinii in Ugandan AIDS patients

Whereas pneumocystis carinii pneumonia (PCP) is one of the major complications and causes of death in patients with the Acquired Immunodeficiency Syndrome (AIDS); patients show that mycobacterium tuberculosis (MTB) is a commoner cause of HIV-associated pneumonia than PCP. Most methods used to diagnose PCP entail invasive and expensive techniques which are beyond the facilities available in developing countries. This study was therefore designed to evaluate spontaneous sputum examination as a cheaper method for the diagnosis of PCP. Sputum specimens collected in 1987 from 54 AIDS patients in Mulago Hospital were stained using a modified Gram stain and read by a competent technician. None of the 54 slides contained evidence of pneumocystis carinii. These results were consistent with other studies in Africa which show that PCP is rare among AIDS patients. [abstract terminated]

Sputum smear examination on a medical ward

Tuberculosis is a common condition in Malawi; and a common cause for admission to the Queen Elizabeth Central Hospital (QECH). Sputum smear examination is vital dignosis; particularly as there are no facilities in the hospital for sputum culture. The results showed important deficiencies in the ward protocol of sputum smear examination. The study was designed to examine the process of sputum collection; sputum results; diagnosis and outcome of patients with suspected PTB who were admitted to the medical wards; QECH in May 1992

Duration of sputum storage for diagnosis of tuberculosis

These two separate studies were conducted to investigate the length of time that sputum can be kept before bacilli lose their acid fast-ness

Use of common reagent containers to stain sputum smears for acid fast bacilli using ziehl-neelsen technque

The use of common reagent containers for mass staining of sputum smears for acid fast bacilli (AFB) by the Ziehl-Neelsen (ZN:) Technique has previously been discouraged for fear of cross contamination. We undertook the present study to ascertain whether this fear has any justification. Out of 1296 smears prepared from 198 specimens including 9 known negative controls; 108 stainings were performed. 70 specimens and all positive controls were repeatedly positive on different stainings. 69 (99) cases and all positive controls were confirmed by culture. No carry over of AFB from positive to negative smears was experienced. Time; cost and staining mess was significantly reduced during mass eestaining. The use of a common container for staining of sputum smears for AFB by the ZN technique is not only economical but also ideal for laboratories where space is insufficient and larg numbers of sputum specimens are involved

Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries

The value of programmes to control pulmonary tuberculosis in developing countries remains the subject of debate. We have examined the cost-effectiveness of chemotherapy programmes for the control of pulmonary sputum-smear-positive tuberculosis in Malawi; Mozambique; and Tanzania. Effective cure rates of 86-90 percent were achieved with short-course chemotherapy and of 60-66 percent with standard chemotherapy. The average incremental costs per year of life saved were US $1.7-2.1 for short-course chemotherapy with hospital admission; $2.4-3.4 for standard chemotherapy with hospital admission; $0.9-1.1 for ambulatory short-course chemotherapy; and $0.9-1.3 for ambulatory standard chemotherapy. Chemotherapy for smear-positive tuberculosis is thus cheaper than other cost-effective health interventions such as immunisation against measles and oral rehydration therapy. Because the greatest benefit of chemotherapy is reduced transmission of the bacillus; treating HIV-seropositive; tuberculosis smear-positive patients would be only slightly less cost-effective than treating HIV-seronegative; tuberculosis-smear-positive patients

Fluorescence microscopy for the diagnosis of smear-negative pulmonary tuberculosis in Ethiopia

Objective: This study aimed to evaluate the diagnostic performance of LED-FM for smear-negative pulmonary tuberculosis in Ethiopia.Methods: A total of 194 adult patients with a cough lasting for more than two weeks, and who had three direct smear-negative sputum tests for Mycobacterium tuberculosis by Ziehl-Neelsen light microscopy, were included. All direct Ziehl-Neelsen-stained smear-negative sputum samples were cultured and were also visualised by LED-FM. Smears for LED-FM were performed from bleach-concentrated sputum sediment. The diagnostic performance of the LED-FM was compared to the culture method (the reference standard).Results: Of the 194 smear-negative sputum specimens analysed, 28 (14.4%) were culture-positive and 21 (10.8%) were LED-FM-positive for M. tuberculosis. However, only 11 of the 21 (52.4%) LED-FM-positive patients had a confirmed tuberculosis diagnosis by culture. Light-emitting diode fluorescence microscopy (FM) had a sensitivity of 39.3% (95% confidence interval: 21.2­57.4) and specificity of 93.9% (95% confidence interval: 90.4­97.6). Ten LED-FM-positive specimens were culture-negative, and all of these specimens had scanty grading (1­19 bacilli per 40 fields on LED-FM).Conclusion: This study showed that implementation of LED-FM on bleach pre-treated and concentrated sputum can significantly improve the diagnosis of smear-negative pulmonary tuberculosis. However, all scanty grade, positive smears by LED-FM need to be confirmed by reference culture method

Mycobacteria in clinical specimens of sputum smear negative adults pulmonary tuberculosis suspects in Mulago Hospital

Mycobacteria in clinical specimens of sputum smear negative adult pulmonary tuberculosis suspects in Mulago Hospital. Background: Sputum smear negative tuberculosis is a major cause of morbidity and mortality among HIV negative and HIV positive patients attending Mulago hospital. The burden of sputum smear negative tuberculosis in Uganda is not known. a few published studies have been conducted on this subject in sub-saharan Africa where the disease burden is quite high. Objectives: The aim of the study was to determine the prevalence of culture positive but sputum smear negative pulmonary TB among adult sputum smear negative pulmonary suspects admitted to Mulago Hospital and to compare the diagnostic yield of different clinical specimens. To compare the clinical and radiological features in culture positive as well as culture negative pulmonary TB suspects above. Design: A descriptive cross-sectional study was carried out on newly admitted patients aged 15-65 years inclusive; who were sputum smear negative; had abnormal X-ray and had clinical features suggestive of pulmonary TB. Consenting patients had sputum bone marrow and blood taken off for mycobacterial cultures; review of their X-rays and HIV serlogy done. Main out come measures was culture positivity on any of the specimens; X-ray disease pattern; clinical characteristics and HIV sero-status. RESULTS: Of the 50 cultures reported; 30(15) were positive for mycobacteria tuberculosis while 2 (2) had mycobcteria other than TB reported. Sputum had the highest postive culture rates with 15 of the 16 culture positive patients; positive on sputum. Of the 63 patients recruited; HIV was found in 76.2(2) had mycobcteria other than TB reported. Sputum had the highest postive culture rates with 15 of the 16 culture positive patients; positive on sputum. Of the 63 patients recruited; HIV was found in 76.2(48) and had an average WHO clinical stage 3. By clinical history and physical findings it was difficult to differentiate between culture positive and culture negative patients although culture positive patients were more likely to have a temperature 37.2o c (P_value 0.05) as oral hairy leukoplakia (P-value 0.5). On chest X-ray a trend towards more pleural effusions and adenopathy was observed in the culture positive patients. CONCLUSION: 1. Culture positive but sputum smear negative pulmonary TB is 30prevalent among newly admitted adult sputum smear negative pulmonary TB suspects in Mulago Hospital. 2. Sputum as a specimen had the highest positive culture rate and therefore if one has to culture; he/she should use the sputum in such patients. 3. it is difficult by way of clinical and radiological features to differentiate between sputum smear negative but culture negative pulmonary TB suspects although culture positive suspects are likely to have a temperature of 37.oC as well as oral hairy leukoplakia and show a trend towards more pleural effusions and hilar adenopathy