ABSTRACT
Background: The microbiological diagnosis of pulmonary TB by direct sputum smear microscopy plays a key role in routine diagnosis of TB and treatment follow up in Tuberculosis Control Programs in India. Direct smear preparation of clinical samples is hazardous for technicians working in centers without a bio-safety hood. Studies have shown that sensitivity of smear microscopy can be improved if the sputum sample is liquefied with one or more chemical reagents and then concentrated by centrifugation or sedimentation before acid fast staining. The present study aimed to quantify the gain in positivity of microscopic detection and to test its implementation in a peripheral laboratory participating. Methods: This is a prospective observational study were conducted in the Department of Microbiology, Kamineni Institute of Medical Sciences, Narketpalli, Nalgonda, Telangana, India. A total of 100 patients, of all age groups and sex, presenting to the OPD for the first time, with clinical suspicion of pulmonary or extrapulmonary TB was included in the study. All the demographic details of the patients were noted and consent was taken from patients. Salivary samples were immediately removed and a new sample was requested. The time between sputum collection and analysis was recorded. Results: In present study the 100 patients enrolled, the male/female ratio was 1.32, the mean age was 57 years (range 10–85), and 92% of patients were sampled for TB case detection. Only one patient had known HIV infection. Overall, AFB were detected on 44 smears prepared by the direct method (12.3%) and 55 smears prepared by the bleach method (16.0%), a statistically significant difference (P = 0.0006), giving an increase in positivity. The semi-quantitative results highlighted a significant gain in positivity (P < 0.001) with the bleach method. Conclusion: Our study, conducted in a population with a low prevalence of HIV/AIDS, confirms the benefits of the bleach method for the microscopic case detection of pulmonary TB. This rustic, simple and inexpensive method could easily be integrated into the routine of a peripheral laboratory after a short training period and strengthening of quality assurance.
ABSTRACT
Background: Tuberculosis (TB) is a highly prevalent chronic infectious disease caused by Mycobacterium tuberculosis an aerobic intracellular binding bacterium (bacillus). Active TB disease can be fatal if left untreated. The disease today is considered curable and preventable. This retrospective study was undertaken to compare and analyzed the relationship between acute phase reactant proteins CRP (quantitative) and ESR in sputum smear positive for AFB patients and to evaluate their diagnostic and prognostic significance. Methods: The present prospective study was carried on a randomly selected study group comprising of 180 cases of pulmonary TB patients who were sputum smear positive for AFB and 25 normal healthy (sputum smear negative for AFB) individual were taken as control. The cases of PTB group was further categorized on the basis of recommendation of RNTCP grading system of AFB in Sputum ZN staining into four subgroups AFB – 3+, AFB – 2+, AFB –1+ and scanty. The control groups were negative for the Acid Fast bacilli in sputum. Results: In our study showed that the maximum patients seen in grade III (36.11%) followed by grade II (31.66%), grade I (19.44%) and 12.77% scanty according to RNTCP grading system of ZN staining of sputum for acid fast bacilli. The distribution of mean values of CRP, ESR in different grades of ZN staining of sputum in AFB positive patients as well as controls. CRP mean value was 55.4, 40.8 & 22.9 in grade III, grade II & grade I respectively and ESR was 48.1, 38.8 & 23 respectively in different grading significantly higher (p vol < 0.0001) in group II there were no serious adverse reactions in either group. Conclusions: Our study concluded that during the compression of values of CRP and ESR along with the grading of sputum AFB positive patients, the CRP raised more significantly as compare to ESR; with markedly raised values in all the grades of sputum AFB positive patients.