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ObjectiveTo compare the efficacy between the Mycob.T scanner system and manual microscopy for detecting acid-fast bacilli in sputum specimens. MethodsBetween January and November 2020， a total of 1 519 sputum samples from suspected primary tuberculosis patients from 5 designated tuberculosis hospitals in Shanghai were examined by Smear and BACTEC MGIT 960 liquid culture （liquid culture） methods. Each specimen was subiected to 2 direct smear slides. One slide was stained by Z-N method and examined with manual microscopic method. Another slide was stained and scanned by the Mycob.T system. The efficacy of manual microscopy and the Mycob.T scanner system for detecting acid-fast bacilli in sputum specimens was compared based on the result of liquid culture. Results of the repetitive scanning by the Mycob.T scanner system and the recheck of the manual microscopy were analyzed. ResultsThe average positive rate by the Mycob.T scanner system was 14.4% （219/1 519） while the average positive rate by manual microscopy was 16.3% （248/1 519）. No significant difference was observed （χ2=2.13， P=0.145）. Based on liquid culture confirmation results， the sensitivity of manual microscopy （60.36%） was higher than that of the Mycob.T scanner system （52.94%）， and the difference is statistically significant （χ2=4.38， P=0.036）. Both methods had high specificity （98.94%）. The concordance of the Mycob.T scanner system and manual microscopy was 95.46%， with the kappa value of 0.826. The results of repeatability test of the Mycob.T scanner system and the recheck results of the manual microscopy showed that the coincidence rate of scanning by the Mycob.T scanner system was 99.5% （436/438）， and the recheck coincidence rate by the manual microscopy was 98.6% （432/438）. ConclusionThe Mycob.T scanner system have high specificity for detecting acid-fast bacilli in sputum samples and good consistency with the results of manual microscopy. Compared with manual microscopic examination， the Mycob.T scanner system can greatly alleviate the work intensity.
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RESUMEN Introducción: hace más de un siglo, Robert Koch identificó el microorganismo que causa la tuberculosis en el hombre, el Mycobacterium tuberculosis. Sin embargo, aún constituye un grave problema epidemiológico a nivel mundial. Se presentó un estudio realizado en los pacientes ingresados en el Servicio de Infeccioso del Hospital Regional de Malabo. Objetivo: caracterizar los pacientes con tuberculosis ingresados en la primera fase de tratamiento antituberculoso. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo de los pacientes ingresados en el Servicio de Tratamiento de Infecciosos del Hospital Regional de Malabo. Periodo correspondiente a los meses de enero a julio del 2016. El universo fue 172 pacientes con diagnóstico de tuberculosis en todas sus formas clínicas. Los datos se obtuvieron en las historias clínicas. Resultados: predominó el sexo masculino en el 57,5 % de los pacientes y el grupo etáreo de 25 a 34 años con el 33,7 %. La baciloscopia negativa representó el 67,9 % de los casos y el estado nutricional más frecuente fue el bajo peso con 50,09 %. La tuberculosis en su forma pulmonar predominó en el 95,9 % de los pacientes. El 65,6 % de los pacientes fueron VIH negativos. La mejoría clínico radiológica al terminar el tratamiento fue de un 87,7 %. Conclusiones: el 57,5 % de los pacientes fueron masculinos entre 25 y 34 años de edad. Predominó la Baciloscopia negativa y la tuberculosis en su forma pulmonar. La mejoría clínica radiológica fue superior al terminar el tratamiento (AU).
ABSTRACT Introduction: More than a century ago, Robert Koch identified the microorganism causing tuberculosis in people: Mycobacterium tuberculosis. But it is still a serious epidemiologic problem around the world. The authors presented a study carried out in patients admitted in the Infectious Service of the Regional Hospital of Malabo. Objective: to characterize the patients with tuberculosis admitted in the first stage of the anti-tuberculosis treatment. Materials and methods: a descriptive, retrospective study was carried out on the patients who were admitted in the Infectious Service of the Regional Hospital of Malabo in the period from January to July 2016. The universe were 172 patients with diagnosis of tuberculosis in all its clinical forms. Data were gathered from the clinical records. Results: male sex predominated in 57.5 % of the patients as it also did the 25-34 years-old age group with 33.7 %. Negative sputum smear represented 67.9 % of the cases and the most frequent nutritional status was the low weight with 50.9 %. Tuberculosis in its pulmonary form predominated in 95.9 % of the patients. 65.6 % of the patients were HIV negative. The clinical radiological improvement at the end of the treatment was 87.7 %. Conclusions: 57.5 % of the patients were male aged 25-34 years old. Negative sputum smear and the pulmonary form of tuberculosis predominated. The clinical radiological improvement was higher at the end of the treatment (AU).
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Humans , Tuberculosis, Pulmonary/epidemiology , Comprehensive Health Care , Hospital Care , Health Policy , Tuberculosis, Pulmonary/drug therapy , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
Introduction: India has the highest burden of TB cases inthe world, majority of them are pulmonary tuberculosis.The method of choice for diagnosis of PTB is microscopicexamination of AFB by sputum smear. However, 30 to 50%of patients with pulmonary tuberculosis can have negativesputum report or may not produce sputum. Flexible fibreopticbronchoscopy can provide excellent material for diagnosis forpatients with suspected sputum smear negative pulmonarytuberculosis. Study aimed to evaluate the role of fiberoptic bronchoscopy in sputum smear negative pulmonorytuberculosis.Material and methods: Forty suspected cases of pulmonaryTB with clinical and radiological evidence of tb and sputumsmear negative on 2 occasions were selected for thisprospective nonrandomised observational study. Detailedexamination of the bronchial tree was done and specimensincluding bronchial aspirate and lavage was collected andsend for investigations. Post bronchoscopy sputum (PBS) wasalso collected and sent for smear microscopy.Results: In our study of 40 patients, tuberculosis wasconfirmed in 13 (32.50%) by smear examination of AFB inBroncho alveolar fluid and by post bronchoscopy sputumsmear examination in 3/40 (7.5%) cases. A definitive diagnosisof tuberculosis was possible in 23 (57.5%) of the 40 patientsby AFB culture by BACTEC MGIT960.Conclusion: Fibreoptic bronchoscopy with post bronchoscopysputum,BAL and BAL AFB culture is a useful tool fordiagnosis and can thereby prompt treatment of sputum smearnegative pulmonary tuberculosis patients.
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Objective To investigate the application value of Xpert mycobacterium tuberculosis/rifampicin (GeneXpertMTB/RIF) and Hain techniques for the diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance. Methods A total of 254 patients with suspected pulmonary tuberculosis treated in our hospital from March 2018 to June 2019 were enrolled. GeneXpertMTB/RIF, Hain techniques, Roche culture and drug susceptibility testing were performed. Taking Roche culture results as a gold standard, the efficacy of GeneXpertMTB/RIF and Hain techniques in detecting sputum smear-negative pulmonary tuberculosis was analyzed by ROC curve. Based on the results of drug susceptibility testing, the efficacy of GeneXpertMTB/RIF and Hain techniques in detecting rifampicin resistance was analyzed. Results The sensitivity, specificity and accuracy of GeneXpertMTB/RIF in the diagnosis of sputum smear negative pulmonary tuberculosis were 82.18%, 86.93% and 83.52%, respectively. The sensitivity, specificity and accuracy of Hain technique in the diagnosis of sputum smear negative pulmonary tuberculosis were 67.33%, 77.12% and 73.23%, respectively. The sensitivity, specificity and accuracy of GeneXpertMTB/RIF in evaluating rifampicin resistance were 73.33%, 98.84% and 95.05%, respectively. The sensitivity, specificity and accuracy of Hain technique in evaluating rifampicin resistance were 86.67%, 82.56% and 83.17%, respectively. Conclusion Compared with Hain technology, GeneXpertMTB/RIF had better clinical value for diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance. This study demonstrates that GeneXpertMTB/RIF technique has a good application value in the rapid diagnosis and treatment of sputum smear negative pulmonary tuberculosis.
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Humans , Diagnosis , Ethiopia , Health Facilities , Indicators and Reagents , Microscopy , Sensitivity and Specificity , Sputum , TuberculosisABSTRACT
Introduction: Microbiologically confirmed pulmonarytuberculosis patients under Revised National TuberculosisControl Programme (RNTCP) are treated with a 6-monthshort-course chemotherapy (SCC) regimen irrespectiveof co-morbid conditions. The aim of present study was todetermine the time taken for SSC conversion with standardcurrent treatment with anti-tubercular drugs and analysis ofrisk factors if any delaying it. We undertook this prospectivestudy to compare sputum conversion rates (smear) at the endof intensive phase (IP) of Category regimen.Material and methods: was a prospective study which wasconducted for a period of eleven months from August 2018 toJune 2019 at Department of Respiratory Medicine, K.N ChestHospital, S.N Medical College, Jodhpur Rajasthan India.Patients visiting Department of Respiratory medicine and whowere diagnosed as pulmonary tuberculosis by sputum smearexamination were included in study.Result: Sputum smear-positive patients are infectious to closecontacts as well as to community as they continue to expelbacilli for a variable period of time after initiation of DOTSregimen. Most patients undergo sputum conversion by theend of 3rd month. Patients who have predominant cavitatorydisease in radiology, high smear grading before treatment, aprior history of DS/DR tuberculosis are more likely to havedelayed sputum smear conversion.Conclusion: There need to mandate DST at the starting ofDOTS in line with latest RNTCP guidelines to prevent thedevelopment of MDR strains and failures. Also there is astrong need to constitute strong infection control measures tillpatients are labelled as noninfectious.
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Background: Tuberculosis is a chronic, communicable, infectious disease caused by mycobacterium tuberculosis bacilli usually affecting lungs primarily resulting in pulmonary tuberculosis. Objective: The objective of this study was to evaluate the Revised National Tuberculosis Control Program (RNTCP) through the assessment of case detection performance of the patients registered for treatment under RNTCP in tuberculosis units (TUs). Materials and Methods: The present record-based, observational cross-sectional study was carried out under district tuberculosis centre, Satara, involving all the 10 TUs. District tuberculosis centre is located in the campus of District Hospital, Satara. The functioning of RNTCP under district tuberculosis centre at the level of TUs was studied from 2012 to 2014. Fifty slides of sputum smear positive and 50 slides of sputum smear negative for tuberculosis were selected randomly. Results: Tuberculosis suspect rate was found consistently increasing from 2012 to 2014 in majority of TUs except Umbraj TU. Sputum positive rate was also consistently low in Umbraj TU. Sputum positive smear rate was higher in Bel-Air TU consistently from 2012 followed by Satara TU. Annualized new smear-positive case detection rate was higher in Satara and Bel-Air TUs in 2012; however, it was within the range of 68–83% in 2012 which rose to 86.9% in 2013 at Koregaon and 89.5% at Wai TU in 2014. Conclusion: Tuberculosis suspect rate is consistently low at both Umbraj and Bel-Air TU. Sputum smear-positive rate is consistently higher at Satara and Bel-Air TU.
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Background: Tuberculosis is among the most important causes of death from a single infectious agent and a major public health problem causing an enormous burden of disease and economic impact especially in the developing countries. Pulmonary tuberculosis is the most common form of tuberculosis causing >85% of all tuberculosis cases. The smear conversion rate is an operational indicator for the directly observed treatment short course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India.Methods: A longitudinal study was conducted in DMC, RRMCH, in the first two quarters of the year 2013 i.e., from January 1st to June 31st of the year 2013. All 130 adult category I (new) sputum smear positive cases that attended DMC, and registered under RNTCP constituted the sample for the study. Data was collected by interview method by using pre-tested, semi-structured questionnaire. Data was analyzed using SPSS version 20.0.Results: Majority of the study subjects was >50 years, Hindus, illiterates, belonged to nuclear family from rural area belonged to upper lower socio-economic class. The overall sputum smear conversion rate is 92.4%. Lower sputum smear conversion rate was observed in the following risk factors like the male gender, smoking, diabetes, initial high pre-treatment smear grading and poor drug compliance.Conclusions: The overall sputum conversion rate at the end of two months of intensive phase under (DOTS) chemotherapy in 118 sputum smear positive (cat I) new pulmonary tuberculosis patients in Designated Microscopy and Treatment Centre (DMC) Rajarajeswari Medical College and Hospital was 92.4%.
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Abstract INTRODUCTION: The molecular test Xpert MTB/RIF (Xpert) has been recommended for use in the diagnosis of pulmonary tuberculosis (PTB); however, data on the cost of incorporating it under routine conditions in high-burden countries are scarce. The clinical impact and costs incurred in adopting the Xpert test in routine PTB diagnosis was evaluated in a prospective study conducted from November 2012 to November of 2013, in the City of Rio de Janeiro, Brazil. METHODS: The diagnostic and therapeutic cascade for TB treatment was evaluated using Xpert in the first stage (S1), and sputum smear microscopy (SSM) in the second stage (S2). The mean costs associated with each diagnostic test were calculated including equipment, human resources, supplies, and infrastructure. RESULTS: We included 232 subjects with probable TB (S1 = 87; S2 = 145). The sensitivities of Xpert and SSM were 91.7% (22/24) and 79.1% (34/43), respectively. The median time between triage and TB treatment initiation in S1 (n = 24) was 14.5 days (IQR 8-28.0) and in S2 (n = 43) it was 8 days [interquartile range (IQR) 6-12.0]. The estimated mean costs per examination in S1 and S2 were US$24.61 and US$6.98, respectively. CONCLUSIONS: Compared with SSM, Xpert test showed a greater sensitivity, but it also had a time delay with respect to treatment initiation and a higher mean cost per examination.
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Humans , Male , Female , Adult , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Mycobacterium tuberculosis/isolation & purification , Predictive Value of Tests , Sensitivity and Specificity , Costs and Cost Analysis , Diagnostic Tests, Routine/economicsABSTRACT
This paper reports a severe case of Strongyloides stercoralis infection during routine sputum smear examinations, due to cough and shortness of breath, so as to improve clinicians’ awareness of strongyloidiasis to avoid and reduce misdiagnosis and missed diagnosis.
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Objective To evaluate Loop-mediated isothermal amplification(LAMP)method on detecting sputum specimens from patients with tuberculosis.Methods 75 smear-positive sputum specimens and 72 smear-negative sputum samples from patients with tuberculosis were collected from the hospital during De-cember 2016 to April 2017.Each sputum sample was detected by sputum smear microscopy,Roche solid cul-ture(L-J)and LAMP simultaneously.The positive rate of smear-positive,smear-negative,LAMP and L-J cul-ture were calculated and statistically analyzed.Results In the 75 samples of sputum smear positive samples, LAMP method detected all the samples for positive,L-J culture tested 64 for positive.The positive rate of LAMP was 100.0%(75/75),L-J culture was 85.3%(64/75),and showed significant differences between the L-J solid culture and LAM P assay(χ2= 9.09,P<0.05).Among the 72 smear-negative sputum samples,the positive rate of LAMP was significantly higher than that of negative sputum smear[31.9%(23/72)],which was significantly higher than that of L-J culture[16.7%(12/72)],and the difference was statistically signifi-cant(χ2=6.67,P<0.05).Conclusion The LAMP method has higher sensitivity and specificity for detection of M tb than the methods of sputum smear microscopy and L-J culture with the characteristics of rapid,simple and accurate,therefore,it could be used for clinical early detection of TB patients.
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Objective To explore the diagnostic value of sputum smear coupled with simplified clinical pulmonary infection score (CPIS) of ventilator associated pneumonia (VAP) in the early stage.Methods A cohort of 59 consecutive patients with VAP admitted in Intensive Care Unit from June,2014 to June,2016 were enrolled for a prospective and observational study.Concurrently,another 59 patients without pulmonary infection undergone mechanical ventilation over 48 hrs,were assigned into the control group.The criteria of exclusion were patients with pulmonary malignancies,autoimmune diseases and immunodeficiency.APACHE Ⅱ scores of all patients were recorded.All patients' inferior airway sputum which met the criteria was taken to make a validated sputum smear (i.e.polymorphonuclear leukocyte ＞ 25and squamous epithelial cell ＜ 10 per low-power field) for Gram stain and culture on the admission day.Meanwhile,simplified CPIS were calculated.Data were statistically processed by SPSS 15.0,enumeration data were statistically analyzed by Chi-Square test,and measurement data were represented as Mean ± SD.The significant differences in characteristics between two groups were analyzed by independent t test,and P ＜ 0.05 was considered statistically significant.As positive sputum smear and simplified CPIS ≥ 5 were set respectively as a positive screening criterion,sensitivity,specificity,positive predictive value and negative predictive value of each marker and combined markers were calculated.Results There were no significant differences in demographics and clinical features (including age,sex,APACHE Ⅱ scores) of patients in VAP and non-VAP patients (P ＞ 0.05).The rates of bacteria detected were Gram-negative [44.1％ (26/59)],Gram-positive [40.6％ (24/59)],none [10.2％ (6/59)] and both [5.1％ (3/59)] bacteria in VAP group,while [39.0％ (23/59)],[30.5％ (18/59)],[27.1％ (16/59)] and [3.4％ (2/59)]were found in non-VAP group correspondingly.There were no significant differences in the percentages of different bacteria in sputum smear between two groups (P ＞ 0.05).The values of diagnostic sensitivity of sputum smear and sputum smear coupled with simplified CPIS were 89.8％ and 84.7％;the specificity were 27.1％ and 79.7％;the positive predictive values were 55.2％ and 80.6％;and the negative predictive values were 72.7％ and 83.9％,respectively.Conclusions No matter the ventilated patients suffered VAP or not,bacteria might be detected from their lower respiratory tracts.Sputum smear could not be taken as an exclusively diagnostic evidence.While sputum smear coupled with simplified CPIS might improve the diagnostic efficacy of VAP,and provide the guildlines of appropriate choice of antibiotics employed in the early stage.
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Aim: The purpose of this study was to investigate the chest radiographic patterns of smear positive pulmonary tuberculosis patients in relation to HIV co-infection. Study Deign: Cross-sectional descriptive study Place and Duration of the Study: The study was conducted at Gondar University hospital between May 2004–December 2007. Methodology: We studied chest radiographs of 207 (128 HIV negative and 79 HIV positive) consecutive sputum smear positive pulmonary tuberculosis patients according to the standard classification. Mean and percentages/ proportions were used for descriptive analysis. Chi square test was used to measure association. Results: The prevalence of HIV in patients with smear positive pulmonary tuberculosis was 38.2%. The most common chest radiographic patterns were fibronodular (83.1%), cavity (60.4%), lobar consolidation (49.8%), and brochopnemonic consolidation (9.2%). Lymphadenopthy and pleural effusion were more common in HIV co infected patients (p<0.01). Cavities, upper lobe disease and increased mean number of lung lobes involved were more prominent in HIV negative patients (P<0.05). Despite a higher rate of patients with far advanced CXR patterns in HIV negative TBC patients compared to HIV positive (p<0.026), there was no significant difference in the radiographic, sputum smear conversion or clinical response in terms of increased body mass index after 8 weeks of anti TBC treatment between HIV negative and HIV positive patients. Conclusion: Post primary pulmonary tuberculosis was the commonest chest radiographic pattern at presentation in both HIV positive and HIV negative patients, but atypical chest radiographic presentations were associated with co-infection. It was more common for HIV negative tuberculosis patients to have a radiologically far advanced pattern which did not correspond to the clinical and radiological response. This may prompt a need for revision of the current radiological classification.
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Background: Sputum smear microscopy is the main‑stay in the diagnosis of pulmonary tuberculosis in many developing countries. To overcome the drop outs, same day diagnosis is ideal. Materials and Methods: In the current study, two spot sputum samples (SS2 approach) are collected within a gap of one hour (same day sputum smear microscopy) in addition to the standard spot morning (SM) approach. The smears were stained with standard Ziehl Neelsen (ZN) and modified ZN staining techniques. Results: Out of 1537 patients, sputum smear positivity (SSP) was 9.43% (146 patients) in SM approach with standard ZN staining. Smear positivity was increased to 9.8% (151 patients) with modified ZN staining. For SS2 approach, SSP was 9.37% (144 patients) and 9.8% (151 patients) with standard and modified ZN staining procedures, respectively. Conclusions: Diagnosis of lung tuberculosis is possible with two spot sputum samples with modified ZN staining.
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PURPOSE: We investigated the value of an interferon-gamma release assay (IGRA) for the diagnosis of active pulmonary tuberculosis (PTB) among sputum smear negative PTB suspects in an environment with intermediate burden of PTB and high Bacillus Calmette-Guerin (BCG) vaccination rate. MATERIALS AND METHODS: We retrospectively reviewed IGRA, medical records, chest PA and CT scan of PTB suspects seen at Gangnam Severance Hospital, Seoul, Korea from Oct. 2007 to Apr. 2013. "Active PTB" was diagnosed when 1) M. tuberculosis culture positive, 2) confirmation by pathologic examination; or 3) clinical findings compatible with TB. RESULTS: Of 224 sputum smear negative PTB suspects, 94 were confirmed as having active PTB. There were no statistically significant differences in the diagnostic yield of IGRA between immunocompromised and immunocompetent sputum smear negative PTB suspects. IGRA did show superior sensitivity [81.9%, 95% confidence interval (CI); 74.13-89.70%] in the diagnosis of sputum smear negative PTB when compared with chest high-resolution computed tomography (HRCT), tuberculin skin test (TST), and chest X-ray (p<0.001). Also, IGRA showed highest negative predictive value (82.7%, 95% CI; 75.16-90.15%) when compared with HRCT, TST and chest X-ray (p=0.023). However, combining the results of IGRA with those of HRCT, TST, or both did not increase any diagnostic parameters. CONCLUSION: Failure to increase diagnostic yields by combination with other diagnostic modalities suggests that additional enforcement with IGRA may be insufficient to exclude other diagnoses in sputum smear negative PTB suspects and to screen active PTB in an environment with intermediate TB prevalence and a high BCG vaccination rate.
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Adult , Aged , Female , Humans , Male , Middle Aged , Interferon-gamma Release Tests/methods , Retrospective Studies , Sputum/microbiology , Tuberculosis, Pulmonary/bloodABSTRACT
Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.
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Objective To understand the guidance significance of sputum smear on the sputum culture by comparing the micro-scopic detection results of sputum smear with the sputum culture results in 227 cases.Methods 227 cases of sputum specimen were collected for observing the character and smear staining by microscopy.These specimens were divided into the class A,B,C and D according to the standards and simultaneously conducted the culture.The relationship between smear and culture was analyzed.Reˉ sults Among 227 cases of sputum specimen,158 cases were qualified and accounted for 69.60%,and 69 cases were unqualified and accounted for 30.40%.Potential pathogens were detected in 128 cases,the positive detection rate was 56.39%,the positive detec-tion rate of qualified sputum specimens was 70.39% and which of unqualified sputum specimens was 28.00%.The coincidence rate of qualified sputum specimen smear results and the culture results was 72.78%.The positive rate of cytophagic bacteria in the qual-ified sputum specimens was 11.72%,in which 14 cases of cytophagic bacteria were the qualified class A sputum specimens with the positive rate of 16.67% and 5 cases of cytophagic bacteria were the class B sputum specimens with the positive rate of 6.76 %. Conclusion The sputum smear microscopic detection can provide the important information for the diagnosis and treatment of re-spiratory infections and the sputum smear has the important guiding significance for sputum culture.
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Objective To discuss the value of combination of various clinical laboratory methods in the diagnosis of Mycobacteri-um tuberculosis(MTB) .Methods T-SPOT .TB ,sputum smear ,sputum culture ,and MTB-DNA detection were used to detect MTB .The sensitivity ,specificity ,rate of missed diagnosis ,coincidence rate and correct diagnosis index for tuberculosis diagnosis of the four methods and their pairwise combinations were analyzed and compared .Results Comparing with other methods ,T-SPOT . TB combined with MTB-DNA detection had the highest sensitivity ,coincidence rate and correct diagnosis index ,and the lowest rate of missed diagnosis ,with significant difference(P<0 .05) .Conclusion T-SPOT .TB combined with MTB-DNA detection could be used as an adjuvant method for the early diagnosis of tuberculosis .
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El control de calidad de la baciloscopía, es un sistema diseñado para mejorar la habilidad, eficiencia y el uso de la microscopía, como opción de diagnóstico y monitoreo, asegurando que la información generada por el mismo, sea exacta, fiable y reproducible. El objetivo del presente estudio fue evaluar los indicadores de calidad de la baciloscopía, según lo establecido en el programa de control de la tuberculosis en Cuba en los laboratorios de diagnóstico de tuberculosis de los centros municipales de higiene y epidemiología, de Matanzas. Se tomaron el 100 por ciento de las láminas de los casos de tuberculosis diagnosticados y el 10 por ciento de las láminas negativas de todos los centros de salud de la provincia donde se realiza baciloscopia de esputo. Se realizó el control de calidad a 27 481 láminas en el período de enero de 1997 hasta diciembre de 2009, según lo establecido en el Manual de procedimientos, del Programa Nacional de Control de Tuberculosis. De las láminas evaluadas, presentaron codificaciones concordantes 27 444 (99,9 por ciento); codificaciones discrepantes, 3 láminas (0,01 por ciento) y discordantes, 34 (0,12 por ciento). La tasa de error para todos falsos positivos fue de 0,12 por ciento; no se identificaron resultados falsos negativos. Estos resultados sugieren la calidad del personal que realiza la baciloscopía de tuberculosis en los laboratorios y recomendamos no descuidar las continuas supervisiones y mantener un programa de entrenamiento constante de los técnicos para continuar mejorando la calidad del diagnóstico baciloscópico en la provincia de Matanzas.
The control of the sputum smear test quality is a system designed to improve the ability, efficiency and usage of the sputum smear test, as a diagnosis option and a monitoring, guarantying that the generated information is exact, reliable and reproducible. The objective of the current study was assessing the sputum smear test quality indicators in the laboratories of tuberculosis diagnosis at the municipal centers of hygiene and epidemiologic, of Matanzas, according to the parameters established in the program for controlling tuberculosis in Cuba. We took 100 per cent of the slides of the cases diagnosed with tuberculosis and 10 per cent of the negative slides in all the health institutions of the province where sputum smear tests are made. We carried out the quality control of 27 481 slides in the period from January 1997 to December 2009, according to the Handbook of procedures, of the National Program of Tuberculosis Control. Of the assessed slides, 27 444 (99,9 per cent) had concordant codifications, 3 slides (0.01) discrepant and 34 (0,12) discordant ones. The fault rate for all the false negative was 0,12 per cent; no false negative results were identified. These results suggest the quality of the staff making the tuberculosis sputum smear tests in the laboratories and we recommend do not neglect the continual supervision and maintaining a program of technicians constant training to continue improving the quality of the sputum smear test diagnosis in the province of Matanzas.
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Humans , Quality Control , Tuberculosis, Pulmonary/diagnosis , Clinical Laboratory Techniques/methods , Clinical Laboratory TechniquesABSTRACT
O Programa Nacional de Controle da Tuberculose (TB) do Ministério da Saúde utiliza a baciloscopia de escarro como metodologia padrão no diagnóstico da TB pulmonar. Para garantir a qualidade do exame é recomendado o uso de Controle Externo de Qualidade (CEQ) da baciloscopia na rede de laboratórios de diagnóstico de TB. Neste estudo foi avaliada a qualidade das baciloscopias de escarro da rede de laboratórios locais, por meio de supervisão indireta, na Região Metropolitana da Baixada Santista/SP. Em nove laboratórios locais foram analisadas 5.691 baciloscopias, coradas pelo Ziehl-Neelsen. Tais amostras foram avaliadas nos seguintes itens: análise macroscópica (distensão) e microscópica (coloração) dos esfregaços e o índice baciloscópico (C%). Para avaliá-las, utilizou-se a metodologia padrão do Manual Nacional de Vigilância Laboratorial de TB e outras Micobactérias/MS de 2008. Utilizando-se metodologia recomendada, das 713 lâminas analisadas, 529 (74,2 %) foram satisfatórias na avaliação macroscópica e 631 (88,5 %), satisfatórias na avaliação microscópica. Na análise da releitura, uma unidade laboratorial apresentou dois resultados falsos positivos e C = 97,5 %. Embora os resultados encontrados tenham sido aceitáveis, sugere-se a realização de atividades contínuas do CEQ, com ênfase na aplicação de ações corretivas nas principais causas de erro no desenvolvimento da técnica de baciloscopia.
The Brazilian Ministry of Health national program for tuberculosis (TB) control (Programa Nacional deControle da Tuberculose) determines the sputum smear microscopy as the standard methodology for TBdiagnosis. In order to achieve diagnosis quality assurance it is recommended to set up an External QualityAssessment (EQA) scheme in the TB diagnosis laboratory network. This study aimed at evaluating thequality of sputum smear microscopy performed by the local laboratory network of the metropolitanarea of Baixada Santista, SP, by means of an indirect supervision. The 5,691 sputum samples stained withZiehl-Neelsen in nine local laboratories were evaluated. The applied EQA methodology was in accordancewith the National TB and Other AFB Laboratory Surveillance Manual Ministry of Health, 2008. Theanalyzed parameters were: macroscopic (smear uniformity) and microscopic (staining) analyses of thesputum smears and bacilloscopic index (C%). Of 713 analyzed slides, 529 (74.2 %) were satisfactory onmacroscopic features and 631 (88.5 %) on microscopic evaluation. In the slides rechecking, one laboratoryshowed two false-positive results and C =97.5 %. Although the general results have been acceptable, acontinuous EQA activity should be carried out, emphasizing the use of correcting actions on the commonsources of error that may occur in performing the AFB microscopy technique.