Incremental yield in sputum smear positivity by examining a second early morning sputum specimen in follow-up patients on dots: 7 year analysis of RNTCP laboratory register.
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Date
2011-04
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Abstract
Background: Patients receiving DOTS undergo periodic follow-up sputum examination, which aids in monitoring response
to treatment. Continued or new smear positivity at follow up examination entails extension of intensive phase or change in
treatment category and the need for culture and drug susceptibility test.
Setting: Tuberculosis microscopy centre at a tertiary care teaching hospital, Mumbai, India.
Objective: To determine the incremental yield in sputum smear positivity by examining a second early morning sputum
specimen in follow-up patients on DOTS.
Design: Retrospective analysis of follow up sputum microscopy results recorded in tuberculosis laboratory register for the
period 2002-2008.
Results: During the study period, 5015 follow-up patients submitted two early morning sputum specimens, of which
501(9.99 %) patients were detected to be smear-positive. Out of smear positive patients under study, 324 patients had both
specimens positive, 79 patients had only first specimen positive and 98 patients had only second specimen positive. The
incremental yield was 1.95 % of total and 19.5 % of smear positives.
Conclusion: Discordant smears were present in nearly a third of patients detected smear positive during follow-up. More
than half of these patients were detected only by examining second specimen. The incremental yield by examining the
second early morning specimen was 1.95 % of total and 19.5 % of smear positive specimens. It is important to detect each
possible smear positive follow-up patient as they are likely to benefit from altered treatment. The inclusion of a second early
morning sputum specimen examination is essential to maximize their detection.
Description
Keywords
Smear positivity, Incremental yield, Follow up patients, DOTS
Citation
Nataraj Gita, Kanade Swapna, Parikh Raunak, Khatri Vijay, Mehta Preeti, Athavale Amita, Arun Bamne. Incremental yield in sputum smear positivity by examining a second early morning sputum specimen in follow-up patients on dots: 7 year analysis of RNTCP laboratory register. Indian Journal of Tuberculosis. 2011 Apr; 58(2): 60-65.