Impact of Sputum Volume in the Diagnosis of Smear-Positive Pulmonary Tuberculosis.

OBJECTIVE: To find the impact of sputum volume in the diagnosis of smear-positive (SP) pulmonary tuberculosis (PT) and its association with gender. MATERIALS AND METHODS: The study was conducted in the Department of Microbiology, GSL Medical College. PT patients were included and informed to provide good-quality sputum; volume was not mentioned. Smears were stained by Ziehl-Neelsen technique. Based on the volume of sample submitted, the participants were divided into three groups. Chi-square test was used to find the statistical significance; P < 0.05 was considered statistically significant. RESULTS: Volume-wise, 22, 38, and 74 participants submitted sputum, respectively, in groups, <2 mL, 2-5 mL, and >5 mL; statistically, the difference was significant (P < 0.05). The smear positivity was 13% (15), 28% (32), and 59% (68), respectively, in groups, <2 mL, 2-5 mL, and >5 mL; statistically, the difference was significant (P < 0.05). Among the missed cases, the difference was statistically significant (P < 0.05) in males and the difference was statistically not significant (P > 0.05) in females. CONCLUSIONS: Notable number of SP cases are identified in ≤5 mL sputum. Hence, sample should not be discarded/rejected if the volume is <5 mL.

One-sample two-smear versus two-sample two-smear approach for the diagnosis of pulmonary tuberculosis.

BACKGROUND: To evaluate the efficacy of one-sputum sample two-smear approach for the diagnosis of pulmonary tuberculosis (PT). MATERIALS AND METHODS: Data from January 2012 to December 2015 were analyzed to find (1) number of smear positives (SPs) by spot (S) sample with one and two smears; (2) number of SPs by morning (M) sample with one and two smears; and (iii) number of SPs by two samples with two smears, that is, same-day (SS2) and spot morning (SM) approaches. The Chi-square test was used to evaluate the statistical difference in SP cases. RESULTS: With one-sample two-smear approach, the smear positivity (SPT) was 87% and 87.5%, for S and M samples, respectively, for Ziehl-Neelsen (ZN) staining; whereas, SPT was 96% and 97%, respectively, for S and M samples, for fluorescent staining (FS) technique. With two-sample two-smear approach, for ZN staining, SPT was 89% each and for FS technique, SPT was 97% and 99%, respectively, for SS2 and SM approaches. The difference was not statistically significant (P > 0.05) between one- and two-sample approaches in the staining techniques. CONCLUSION: Significant number of SP cases are identified by S sample two-smear approach. Thus, the World Health Organization/Revised National Tuberculosis Control Programme can initiate S sample two-smear approach for the diagnosis of PT.

Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: Ziehl-Neelsen versus fluorescent staining.

BACKGROUND: Sputum smear microscopy is the main tool for the diagnosis of pulmonary tuberculosis (TB), especially in low- and middle-income countries (LMICs). Limited sensitivity of smear microscopy and patient dropouts (PDs) are the important obstacles of national TB control programs. OBJECTIVES: (1) To assess the diagnostic utility of the same day (SS2) approach (2) To compare the smear results of the spot morning (SM) and the SS2 approaches. MATERIALS AND METHODS: The study was conducted in the Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India from January 2011 to February 2015. Three sputum samples were collected [spot (S), second spot (S2) 1 h after S, and morning sample (M)] from the volunteers. The sputum smears were stained by Ziehl-Neelsen (ZN), modified ZN (MZN), and fluorescent staining (FS) techniques and the results were pooled and compared under SM and SS2 approaches. RESULTS: Of the 3,186 study participants, sputum smear positivity (SSP) for SM approach was 9.6% and 10.8% and for SS2 approach, it was 9.4% and 10.6%, respectively, with ZN and FS and the results were statistically insignificant (Mann-Whitney U test, P > 0.05). CONCLUSION: Technically SSP was similar for both the approaches and no improvement was observed with the SS2 approach. Hence, there is an urgent need to improve SSP.

Hepatopleuropulmonary amoebiasis--a case report.

Amoebiasis is a food-borne protozoan infection, caused by Entamoeba histolytica. Here a case of hepatopleuropulmonary amoebiasis, which was detected after fibre-optic bronchoscopy is reported. Bronchial aspirate showed trophozoites of Entamoeba histolytica. The patient was treated with tinidazole and responded favourably.

A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oro pharyngeal spacer.

INTRODUCTION: The tuberculosis control program is based on a felt need-oriented basis. The diagnosis is mainly microbiological. However, sputum smear-negative Acid Fast Bacilli (AFB) cases with suspected radiological findings can be problematic in diagnosis. OBJECTIVES: To confirm the diagnosis of tuberculosis early, in smear-negative AFB cases by using a Fiberoptic Bronchoscope. MATERIALS AND METHODS: We embarked on Fiberoptic Bronchoscopy (FOB) and Spot Scopy smear Microscopy (SSM) for 533 suspected Pulmonary Tuberculosis (PT) cases (sputum smear negative and radiologically suggestive) from February 2007 to May 2010. FOB was performed using a special device, a Trans Oro Pharyngeal Spacer (TOPS), as a conduit. RESULTS: The yield for positivity for AFB was 341 (64%) out of 533 cases. CONCLUSION AND RECOMMENDATION: The specimens collected by using the fiberoptic bronchoscope confirmed the disease in the smear-negative cases. Hence, FOB was recommended in smear-negative cases, to avoid delay in the treatment of tuberculosis.

Same day sputum smear microscopy approach for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry.

BACKGROUND: Sputum smear microscopy is the initial and rapid diagnostic technique for tuberculosis. This requires two (spot and morning SM) sputum sample examinations over two days. Collection of two spot samples (SS2) on the same day would reduce the number of visits, time, money and early initiation of treatment. METHODS: We evaluated same day approach (SS2) against standard (SM) for the diagnosis of pulmonary tuberculosis. RESULTS: Out of 658 participants, same day approach could identify 62 cases, whereas standard approach could identify 64 cases. Both the approaches are equally effective (p > 0.05). CONCLUSION: The diagnosis of pulmonary tuberculosis is possible in one day by examining two spot samples.