Sputum smear examination and time to diagnosis in patients with smear-negative pulmonary tuberculosis in the Pacific

Abstract

is performed, read and interpreted by a clinician, and a clinical assessment. This may result in delays in diagnosis, 6 which in turn can be associated with progression of disease, worse treatment outcome and spread of TB in the community. [7][8][9] To our knowledge, there is little local or published evidence about the practice of or time taken for diagnosing smear-negative PTB in the Pacifi c Islands, although TB surveillance data are reported annually. 1,2 These data report the proportion of all TB cases diagnosed as PTB (both smear-positive and smear-negative) and extra-pulmonary TB, but do not report the number of smears for each case, how this relates to the age and sex of the patients or the time taken for diagnosis. 1,2 Furthermore, one possible reason for an overdiagnosis of smear-negative PTB is that sputum smear examinations are not performed according to national guidelines. Patients may be being diagnosed without laboratory investigation, with the diagnosis based instead only on clinical criteria and CXR fi ndings.We therefore decided to investigate the practice of sputum smear examination in the Pacifi c Islands, focusing on two countries in the subregion of Micronesia where the TB burden is highest. The aim of this study was to determine the practice of sputum smear examination in patients registered with smear-negative PTB over a 5-year period in Kiribati and the Marshall Islands. Specifi c objectives were to determine: 1) the number and proportion of all TB patients registered with smear-negative PTB; 2) in patients registered with smear-negative PTB, whether or not smears were performed and the number of sputum smear examinations performed in relation to age and sex; and 3) the time taken between smear examination in the laboratory and recording the patient as smear-negative PTB in the TB patient register. METHODS DesignThis study was a retrospective, cross-sectional study involving a record review of TB patient registers and TB laboratory registers. SettingThe setting is two Micronesian Pacifi c Island countries, Kiribati and the Marshall Islands. Kiribati is an equatorial country, located about halfway between Australia and Hawaii, while the Marshall Islands are located in the northern Pacifi c. Kiribati is an independent nation, while the Marshall Islands are affi liated with the United States under a Compact of Free Association. Interna onal Union Against Tuberculosis and Lung Disease

Overdiagnosis of and treatment initiation delay in smear-negative pulmonary tuberculosis patients [Editorial]

“…Health solu ons for the poor VOL 2 NO 1 The study participants were TB patients notifi ed in the National TB Programme in Kiribati and the Marshall Islands for the period 2006-2010. The high percentage (42%) of smearnegative PTB cases highlighted two issues: 1) the possible overdiagnosis of smear-negative PTB, and 2) treatment initiation delay in smear-negative patients.…”