A Pilot Study of Short-Duration Sputum Pretreatment Procedures for Optimizing Smear Microscopy for Tuberculosis

Daley, Peter; Michael, Joy Sarojini; Kalaiselvan, S; Latha, A; Mathai, Dilip; John, K. R.; Pai, Madhukar

doi:10.1371/journal.pone.0005626

Cited by 15 publications

(17 citation statements)

References 20 publications

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“…However, digestion and concentration of debris may also increase the number of false-positive results (7). Consistent with these observations, we found that bleach centrifugation microscopy was more sensitive than direct microscopy.…”

Section: Vol 48 2010 Bleach Microscopy For Tb Diagnosis 2437supporting

confidence: 89%

“…The pooled sensitivity was higher for bleach centrifugation (65%; 95% CI, 59 to 71%) than for direct (56%; 95% CI, 49 to 63%) microscopy. The results were similar when the two studies that used fluorescence staining (study b of Eyangoh et al [9] and the study of Daley et al [7]) were excluded from the analysis (data not shown). When sensitivity differences were pooled across studies, bleach centrifugation microscopy was 6% (95% CI, 3 to 10%; P ϭ 0.001) more sensitive than direct microscopy.…”

Section: Resultsmentioning

confidence: 61%

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Does Bleach Processing Increase the Accuracy of Sputum Smear Microscopy for Diagnosing Pulmonary Tuberculosis?

et al. 2010

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Bleach digestion of sputum prior to smear preparation has been reported to increase the yield of microscopy for diagnosing pulmonary tuberculosis, even in high-HIV-prevalence settings. To determine the diagnostic accuracy of bleach microscopy, we updated a systematic review published in 2006 and applied the Grading of Recommendations Assessment, Development, and Evaluation framework to rate the overall quality of the evidence. We searched multiple databases (as of January 2009) for primary studies in all languages comparing bleach and direct microscopy. We assessed study quality using a validated tool and heterogeneity by standard methods. We used hierarchical summary receiver operating characteristic (HSROC) analysis to calculate summary estimates of diagnostic accuracy and random-effects meta-analysis to pool sensitivity and specificity differences. Of 14 studies (11 papers) included, 9 evaluated bleach centrifugation and 5 evaluated bleach sedimentation. Overall, examination of bleach-processed versus direct smears led to small increases in sensitivity (for bleach centrifugation, 6% [95% confidence interval {CI} ‫؍‬ 3 to 10%, P ‫؍‬ 0.001]; for bleach sedimentation, 9% [95% CI ‫؍‬ 4 to 14%, P ‫؍‬ 0.001]) and small decreases in specificity (for bleach centrifugation, ؊3% [95% CI ‫؍‬ ؊4% to ؊1%, P ‫؍‬ 0.004]; for bleach sedimentation, ؊2% [95% CI ‫؍‬ ؊5% to 0%, P ‫؍‬ 0.05]). Similarly, analysis of HSROC curves suggested little or no improvement in diagnostic accuracy. The quality of evidence was rated very low for both bleach centrifugation and bleach sedimentation. This updated systematic review suggests that the benefits of bleach processing are less than those described previously. Further research should focus on alternative approaches to optimizing smear microscopy, such as lightemitting diode fluorescence microscopy and same-day sputum collection strategies.Sputum smear microscopy is a century-old test but remains the primary tool for diagnosing tuberculosis (TB) in low-income countries. Laboratories typically prepare Ziehl-Neelsenstained smears from unconcentrated sputum (direct smears). Direct smear microscopy is inexpensive, rapid, and highly specific in settings where tuberculosis is endemic. However, direct smear microscopy has poor sensitivity (range, 20 to 80%), particularly in HIV-coinfected patients (24). Processing of sputum by chemical and/or physical methods is commonly used in middle-and high-income countries to increase the diagnostic sensitivity. Although such processing methods usually require expensive chemicals and/or equipment, the Stop TB Partnership Retooling Task Force identified bleach sedimentation as one of three promising approaches to improving the sensitivity of sputum smear microscopy in high-burden countries (29).Bleach (sodium hypochlorite) is an ideal chemical processing agent for use in low-income countries. It is widely available and inexpensive, and its disinfectant properties could improve infection control in laboratories lacking adequate biosafety facilities (3). Bleac...

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Section: Vol 48 2010 Bleach Microscopy For Tb Diagnosis 2437supporting

confidence: 89%

Section: Resultsmentioning

confidence: 61%

Does Bleach Processing Increase the Accuracy of Sputum Smear Microscopy for Diagnosing Pulmonary Tuberculosis?

et al. 2010

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“…In order to control TB in Iran, attention should be paid to the quantity and quality of sputum smear. Sputum pretreatment procedures to optimize smear microscopy should be done in Iran (23). Prospective studies in Iran on a larger number of patients, considering the clinical diseases, quantity and quality of sputum, culture sputum, PCR, and viability stain microscopy with fluorescein diacetate are suggested.…”

Section: Discussionmentioning

confidence: 99%

The Follow-up of 360 Patients with Pulmonary Tuberculosis After 2 Months Treatment With Anti-tubercular Agents in Iran

Kazerani

Ashrafzadeh

et al. 2017

Arch Clin Infect Dis

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Background: Tuberculosis (TB) is a major global health problem. The goal is to end the global TB epidemic. TB treatment averted 49 million deaths globally from 2000 to 2015. If everyone with TB had a timely diagnosis and high-quality treatment, the TB case fatality rate would be lower in all countries. The main source of infection is untreated smear positive pulmonary TB; the next step should be the examination of the sputum for Mycobacterium sp. Bacteriologic evaluation through culture and /smear microscopy is essential to monitor the response to treatment. Monitoring acid-fast bacilli (AFB) smear should be undertaken at 2, 5, and 6 months. The currently recommended treatment for the new cases of drug-susceptible TB is a 6-month regimen of 4 first-line drugs: isoniazid (INH), rifampin (RIF), ethambutol (ETM), and pyrazinamide (PZA). Treatment success rates of at least 85% for new cases of drugsusceptible TB are regularly reported to the world health organization (WHO) by its 194 member states. The global TB drug facility supplies a complete 6-month course for about US$ 40 per person.

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“…Ziehl Neelsen's (ZN) staining of sputum smear is the most widely used diagnostic technique for M. tuberculosis in developing countries, but it has limitation of the presence of minimum 1000 bacili/ mL of sputum sample [16]. The culture isolation technique is the gold standard method for tuberculosis diagnosis is, but require longer time duration for growth of M.tuberculosis isolates [17].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

RJLBPCS

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ABSTRACT:The study was carried out to investigate the socio-demographic characteristics and co-morbidity of patients suffering from tuberculosis from selected hospitals of Faisalabad and Lahore, Pakistan. A total of 366 patients were included in the study. The ZN microscopy was carried out along with PCR. The socio-demographic characteristics of each patient were recorded along with any comorbidity. All the patients under study were found positive by ZN staining, while, 258 (70.5%) were found positive by PCR. Of these 258 patients, 52% were females and 48% were males. The 36.8% patients were between 16-30 years, 40% had a body weight between 41-50 Kg, 75.6% were married, 51.9% were uneducated, while 41.8% had education up to ten grades, and 38% were housewives. Tuberculosis alone was present in 36.8% cases, while 63.2% patients had other disease conditions as well. Out of 63.2%, 24% had diabetes, 17.8% had hepatitis virus infection, 11.2% had diabetes and hepatitis (HCV) together, 4.2% had HIV infection, 12.3% had both HIV and HCV infections together and 3.4% had myocardial infarction. Among TB patients 52% were females, 75.6% were married and 51.9% uneducated. The 63.2% patients had comorbidity of which 24% had diabetes, 17.8% viral hepatitis, 4.2% HIV and 3.4% myocardial infarction.

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A Pilot Study of Short-Duration Sputum Pretreatment Procedures for Optimizing Smear Microscopy for Tuberculosis

Cited by 15 publications

References 20 publications

Does Bleach Processing Increase the Accuracy of Sputum Smear Microscopy for Diagnosing Pulmonary Tuberculosis?

Does Bleach Processing Increase the Accuracy of Sputum Smear Microscopy for Diagnosing Pulmonary Tuberculosis?

The Follow-up of 360 Patients with Pulmonary Tuberculosis After 2 Months Treatment With Anti-tubercular Agents in Iran

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