Smear microscopy as surrogate for culture during follow up of pulmonary MDR-TB patients on DOTS plus treatment.
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Date
2010-07
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Abstract
Background: DOTS Plus site at LRS Institute, New Delhi, covering 1.8 million population.
Aims: To ascertain if sputum smear could be used as a surrogate for culture during intensive phase of treatment of MDRTB
patients thereby enabling early shift from intensive phase to continuation phase, reducing the need for frequent
cultures and saving time and cost in their management.
Methods: The study is a retrospective analysis of 138 MDR-TB patients on DOTS Plus treatment whose sputum
samples were simultaneously subjected to smear microscopy and culture, monthly during Intensive Phase and once in
two months during Continuation Phase. Sputum results in the treatment card were supplemented from laboratory
register, if required, and analyzed. Predictive values, sensitivity and specificity of smear were compared with culture
results.
Results: The Negative Predictive Value (NPV) of smear was high from the 3rd month onwards (above 91%), at four
months 98% or more and approached 100% from eight months onwards. The specificity of smear test gradually
increased during treatment and from five months onwards, it was above 90%.
Conclusions: Considerable correlation was observed between sputum smear and culture during follow up of DOTS Plus
treatment in the Intensive Phase. Accordingly, sputum smears can be recommended instead of culture.
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Keywords
Sputum smear, Culture, MDR-TB, DOTS Plus
Citation
Sarin R, Singla R, Visalakshi P, Jaiswal A, Puri M M, Khalid U K, Mathuria K, Singla N, Behera D, Sharma P P. Smear microscopy as surrogate for culture during follow up of pulmonary MDR-TB patients on DOTS plus treatment. Indian Journal of Tuberculosis. 2010 Jul; 57(3): 134-140.