Judging respiratory specimen acceptability for AFB microscopy: visual <i>vs.</i> microscopic screening

Khan, Mishal; Dar, Osman; Tahseen, Sabira; Godfrey‐Faussett, Peter

doi:10.1111/j.1365-3156.2009.02260.x

Cited by 13 publications

(9 citation statements)

References 6 publications

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“…The poor performance of macroscopic assessment found in our study differs from the observation by Kahn et al, who stated that macroscopic assessment was a valid approach for identification of smear-positive respiratory specimens [9]. This conclusion was based on the fact that macroscopic assessment rejected the least number of specimens in this study.…”

Section: Discussioncontrasting

confidence: 99%

“…Using these algorithms for assessing the possibility for adequate AFB microscopy has been much less examined. A previous study on the usefulness of macroscopic assessment of respiratory specimens for AFB diagnosis was carried out in a routine TB diagnostic setting [9]. This implies a passive case finding strategy in which individuals report themselves to a health facility because of symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Macroscopic and Microscopic Assessment of Specimens Collected for the Diagnosis of Tuberculosis

Hossain

Uddin

Rahman

et al. 2012

TOIDJ

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Diagnosis of tuberculosis in a field setting depends on the quality of specimens submitted for smearmicroscopy. Macroscopic assessment (sputum or saliva) of the specimen for suitability for further examination is common practice in routine care. We examined whether macroscopic assessment could correctly identify sputum specimens based on four published algorithms using microscopic features in the setting of active case finding in a community survey. The study included 901 randomly selected adults who reported cough for 3 weeks or more in the national tuberculosis prevalence survey in Bangladesh. A single specimen of each was assessed with microscopy and microscopy (Gram-stain) to classify it as either sputum or saliva. The primary outcome was the agreement between the two assessment methods (Kappa statistic) From 901 specimens, 561 (62%) were macroscopically classified as saliva and 340 (38%) as sputum. From these, 888 Gram-stained slides could be examined for microscopic features. The agreement between the macroscopic assessment with any of the four microscopy algorithms for sputum was very poor (all Kappa's below 0.1). While macroscopic assessment of submitted specimens might be of value in routine care, it is not warranted in a setting of active case finding in a community survey. Submitting a specimen in the first place should be the primary goal in this setting.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Macroscopic and Microscopic Assessment of Specimens Collected for the Diagnosis of Tuberculosis

Hossain

Uddin

Rahman

et al. 2012

TOIDJ

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“…Khan et al (128) found that, despite being the least technical and time-consuming method, visual assessment to determine whether the specimen is sputum or saliva rejected the lowest proportion of AFB-positive specimens (0.3%). Most microscopic grading criteria, particularly those that considered the squamous epithelial cell count, rejected a large proportion of specimens (30 to 66%), a sizeable fraction of which contained AFB (6 to 12%).…”

Section: Acceptable Specimens and Rejection Criteriamentioning

confidence: 99%

Practical Guidance for Clinical Microbiology Laboratories: Mycobacteria

et al. 2018

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Mycobacteria are the causative organisms for diseases such as tuberculosis (TB), leprosy, Buruli ulcer, and pulmonary nontuberculous mycobacterial disease, to name the most important ones. In 2015, globally, almost 10 million people developed TB, and almost half a million patients suffered from its multidrug-resistant form. In 2016, a total of 9,287 new TB cases were reported in the United States. In 2015, there were 174,608 new case of leprosy worldwide. India, Brazil, and Indonesia reported the most leprosy cases. In 2015, the World Health Organization reported 2,037 new cases of Buruli ulcer, with most cases being reported in Africa. Pulmonary nontuberculous mycobacterial disease is an emerging public health challenge. The U.S. National Institutes of Health reported an increase from 20 to 47 cases/100,000 persons (or 8.2% per year) of pulmonary nontuberculous mycobacterial disease among adults aged 65 years or older throughout the United States, with 181,037 national annual cases estimated in 2014. This review describes contemporary methods for the laboratory diagnosis of mycobacterial diseases. Furthermore, the review considers the ever-changing health care delivery system and stresses the laboratory's need to adjust and embrace molecular technologies to provide shorter turnaround times and a higher quality of care for the patients who we serve.

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“…Considering that WHO plans to change the current “spot-morning” sputum submission to “spot-spot” sputum submission for smear microscopy [9,10] and that the smear positivity yield of spot sputum is lower than that of morning sputum [11], development of quality criteria that could guarantee sputum specimens of adequate quality is crucial. Although various kinds of quality criteria regarding specimen gross appearance and volume [3-6,8,12-14] are recommended to be checked upon collection, these criterias are based not on a well-designed study, but on expert opinion [15]. The purpose of this study was to elucidate the impact of sputum specimen gross appearance and volume on smear positivity in patients suspected to have pulmonary TB, according to sex.…”

Section: Introductionmentioning

confidence: 99%

Impact of sputum gross appearance and volume on smear positivity of pulmonary tuberculosis: a prospective cohort study

2012

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BackgroundAlthough checking specimen quality upon sputum collection for acid-fast smear of suspected tuberculosis (TB) cases is recommended, this procedure is based on expert opinion. The purpose of this study was to elucidate the impact of sputum gross appearance and volume on smear positivity among patients with suspected pulmonary TB, according to sex.MethodsFrom November 2010 through June 2011, we enrolled consecutive patients suspected to have active pulmonary TB. The association of sputum gross appearance and volume with smear positivity, along with other variables possibly affecting smear positivity such as symptoms, disease extent, and cavity on chest radiograph, were investigated.ResultsAmong 2,439 patients undergoing TB examination, 170 (113 men, 57 women) with active pulmonary TB were enrolled. They submitted 492 sputa. There were 73 smear-positive patients (42.9%) and 164 smear-positive sputa (33.3%). While gross appearance was associated with smear positivity in both sexes (purulent or blood-tinged sputum (rather than mucoid sputum or saliva); odds ratio (OR), 2.05, 95% confidence interval (CI), 1.21–3.47 in men; OR, 2.78, 95% CI, 1.23–6.26 in women), the amount of sputum specimens was associated with smear positivity in only female patients (≥4 ml versus <4 ml; OR, 4.96, 95% CI, 1.98–12.37).ConclusionsSputum gross appearance and volume were associated with smear positivity. A volume of 4 ml seems to be the the minimum sputum volume acceptable for smear microscopy in females suspected of TB. Those suspected of TB should be encouraged to expectorate grossly qualified sputum specimens.

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Judging respiratory specimen acceptability for AFB microscopy: visual vs. microscopic screening

Cited by 13 publications

References 6 publications

Comparison of Macroscopic and Microscopic Assessment of Specimens Collected for the Diagnosis of Tuberculosis

Comparison of Macroscopic and Microscopic Assessment of Specimens Collected for the Diagnosis of Tuberculosis

Practical Guidance for Clinical Microbiology Laboratories: Mycobacteria

Impact of sputum gross appearance and volume on smear positivity of pulmonary tuberculosis: a prospective cohort study

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