Factors Influencing Time to Sputum Conversion Among Patients with Smear‐Positive Pulmonary Tuberculosis

Abstract

This parent BCG strain was distributed widely, and the distributed and may have become further attenuated in the process [6].All BCG substrains share a 10-kb deletion (RD1), which may Although there is much to be learned by comparing substrains, a crucial question is whether any BCG substrain should be used in populations with high rates of both HIV infection and tuberculo- Factors Influencing Time to Sputum Conversion Among sis. We demonstrated a high mortality among patients with AIDS Patients with Smear-Positive Pulmonary Tuberculosisand disseminated BCG disease, but we could not determine the rate of this complication. In contrast, in some countries up to half of patients with AIDS develop tuberculosis. If BCG vaccination SIR-The editorial by Iseman [1] raises important issues about the duration of respiratory isolation for patients hospitalized with is even moderately efficacious in preventing tuberculosis in patients with AIDS, then the benefits will outweigh the risks. One tuberculosis. However, his response to our article had little to do with the data we presented and much more to do with his objections population-based study showed that the risk of disseminated BCG disease is low for adults with AIDS who were vaccinated as chilto the 1994 Centers for Disease Control and Prevention (CDC) guidelines for the prevention of nosocomial transmission of tuberdren and that childhood BCG vaccination is associated with protection against Mycobacterium tuberculosis bacteremia [9]. We are culosis [2]. The point of our paper was to quantify the time to sputum conversion, which the title clearly indicates, and, by implicurrently participating in an international study to further address this question.cation, quantify the number of hospital days required to meet CDC guidelines [3]. This paper was not intended, explicitly or implicitly, M. tuberculosis still causes the deaths of more adults than any other infectious agent. BCG is our only tuberculosis vaccine, but to be a public policy paper, and we never suggested that the guidelines be adopted by other physicians in different clinical settings. it has limited efficacy and causes important complications. The development of an improved tuberculosis vaccine is a pressing Although there is much in Iseman's editorial that we agree with, given the greatly improved situation in 1997 in New York public health priority.City with respect to tuberculosis control, the situation several years ago was very different.

A Cholesterol-Rich Diet Accelerates Bacteriologic Sterilization in Pulmonary Tuberculosis

“…Interestingly enough, this favorable effect was evident even when the experimental group had a higher proportion of patients with cavitary lesions and a trend to have more AFB in their initial sputum smear, two conditions that have been described to be associated with a prolonged time for sputum culture conversion. 30 Patients in the control group followed a clinical and bacteriologic evolution that was similar or better than the course already described in a number of studies. Thus, in our study the median time to obtain the first negative sputum culture result was 28 days, which was very similar to the 26 days found by Telzak et al 30 Likewise, the sputum culture result became negative in 73% of our patients after the first month of treatment, which was comparable to the 69% found by the British Medical Research Council.…”

“…30 Patients in the control group followed a clinical and bacteriologic evolution that was similar or better than the course already described in a number of studies. Thus, in our study the median time to obtain the first negative sputum culture result was 28 days, which was very similar to the 26 days found by Telzak et al 30 Likewise, the sputum culture result became negative in 73% of our patients after the first month of treatment, which was comparable to the 69% found by the British Medical Research Council. 31 Therefore, we can reasonably affirm that differences in the outcome between the groups were not due to a less-than-expected responsiveness of the control group.…”

The effect of vitamin A and zinc supplementation on treatment outcomes in pulmonary tuberculosis: a randomized controlled trial

“…Compared with the participants in the Karyadi et al study, our study participants were more likely at baseline to have higher-grade sputum smear positivity (36% 3+ compared with 7.5% 3+) and to have pulmonary cavities (73% compared with 37.5%) (18). Both of these factors are known to be associated with longer sputum smear and culture conversion times (33). However, our failure to find a benefit for the micronutrient intervention is in keeping with 2 other studies: a second Indonesian trial, as yet unpublished, found no improvement in sputum smear conversion with zinc and vitamin A (34), and a Tanzanian trial reported no effect of a multimicronutrient intervention or zinc on sputum culture conversion at 2 mo (21).…”

Inhaled Drug Delivery for Tuberculosis Therapy

“…This may be due to either previously existing drug-resistant strains or the emergence of resistant strains due to the failure of systemic drugs to reach extensive cavitary disease in the lungs that contain numerous acid fast bacilli (AFB) (116). The same authors have shown that HIVpositive individuals converted to smear negative at a faster rate than HIV-negative patients.…”