The Incidence and Clinical Implication of Sputum with Positive Acid-Fast Bacilli Smear But Negative in Mycobacterial Culture in a Tertiary Referral Hospital in South Korea

Lee, Jae Seok; Kim, Eui-Chong; Joo, Sei Ick; Lee, Sang‐Min; Yoo, Chul‐Gyu; Kim, Young Whan; Han, Sung Koo; Shim, Young‐Soo; Yim, Jae Joon

doi:10.3346/jkms.2008.23.5.767

Cited by 27 publications

(22 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are also bacteria with positive ARB microscopy other than mycobacteria (Nocardia, etc.) (32,33). In our study, 207 (2.7%) specimens that were found positive with the staining method were not found positive with any other methods we used.…”

Section: Discussionmentioning

confidence: 73%

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Çelik¹,

Gözel²,

Bakıcı³

et al. 2015

Turk J Med Sci

View full text Add to dashboard Cite

The aim of this study is to assess the Xpert MTB/RIF assay for diagnosis of the Mycobacterium tuberculosis complex in clinical samples and to compare the results by reference to the diagnostic method, Bactec MGIT 960. Materials and methods:A total of 7407 samples were included from patients not primarily suggesting pulmonary or extrapulmonary tuberculosis (TB), collected from patients required to be screened for TB and excluding TB diagnoses since it was a differential diagnosis. Also included were a total of 411 samples from patients primarily suggesting pulmonary or extrapulmonary TB.Results: In the first group, 152 of 7407 samples yielded positive results with the Bactec MGIT 960, 131 (1.77%) were found positive with Löwenstein-Jensen medium, and 295 (3.99%) were found positive with Ziehl-Neelsen staining. In the second group, 24 (5.8%), 17 (4.1%), and 28 (6.8%) of 411 samples were found positive. Xpert MTB/RIF [27 (6.6%) of 411 samples] detected 3 additional samples as positive, and these 3 cases were clinically compatible with TB. Conclusion:The Xpert MTB/RIF assay shows superior performance for the diagnosis of TB. Its usefulness in culture-negative patients and the best method for integrating this diagnostic method into current tuberculosis diagnostic algorithms both need further study.

show abstract

Section: Discussionmentioning

confidence: 73%

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Çelik¹,

Gözel²,

Bakıcı³

et al. 2015

Turk J Med Sci

View full text Add to dashboard Cite

show abstract

“…Nonviable bacilli in sputum and NTM colonisation may lower the specificity as well [28][29][30]. Visible AFB in sputum with negative results from sputum MTB culture occurred in 50 patients in our study, including 40 patients who were pretreatment sputum AFB smear-positive and 10 patients who were pre-treatment sputum AFB smear-negative.…”

Section: Discussionmentioning

confidence: 86%

Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis

Jy²,

Yc³

et al. 2010

Eur Respir J

View full text Add to dashboard Cite

Sputum smears and culture conversion are frequently used to evaluate treatment response in pulmonary tuberculosis patients. Limited data are available on the evaluation of the correlation between under-treatment sputum smear results and culture conversion.This prospective study included sputum culture-proven pulmonary tuberculosis patients at six hospitals in Taiwan. At least two sets of sputum were collected at the completion of 8 weeks of TB treatment. The sensitivities and specificities of 2-month sputum smears were estimated based on culture conversion status.A total of 371 patients were enrolled for analysis. Factors associated with culture conversion included having a smear positive before treatment, presence of a cavity on radiography, rifampicin resistance and usage of the DOTS (directly observed therapy, short course) strategy. The sensitivities of 2-month sputum smears for culture conversion among all patients, initially smear-positive patients and initially smear-negative patients were 64.3, 71.4 and 38%, respectively, and the specificities were 81.6, 69.9 and 92.8%, respectively. In patients who were 2-month sputum smear-positive, the 2-month culture conversion rate was 80% if the patients were under DOTS and without cavitary lesions in radiograms.The predictive value of 2-month sputum smears in culture conversion was limited and highly influenced by clinical factors in pulmonary tuberculosis patients.KEYWORDS: Culture, directly observed therapy short course implementation, Mycobacterium tuberculosis, pulmonary tuberculosis, sputum P ulmonary tuberculosis (PTB) is an airborne infectious disease that requires multiple-drug combination therapy and long treatment duration. Despite great advances in molecular diagnosis, sputum cultures of Mycobacterium tuberculosis (MTB) remain the gold standard for PTB diagnosis. After initiation of anti-tuberculosis (anti-TB) treatment, sputum acidfast bacilli (AFB) smears and cultures of MTB are regularly checked during the treatment period and serve as important indicators of treatment response. Achievement of sputum sterilisation, which is determined by sputum culture conversion, is a cardinal index of treatment success. Previous studies have demonstrated that the time to sputum negativity is an important determinant of relapse [1][2][3]. Failure to achieve sputum culture conversion in ,2 months will lead to a worse treatment outcome [4]. Documentation of sputum culture conversion is also recommended as a necessary criterion before completion of anti-TB treatment in current treatment guidelines [5]. Based on the high predictive value of sputum culture conversion in treatment response [4,6,7], identification of the clinical factors that are associated with a lower sputum culture conversion rate is of crucial importance in PTB management [8][9][10].In spite of the high accuracy of sputum culture conversion in the assessment of treatment response, the long yield time limits its usefulness in clinical practice. As a simple and rapid test, sputum smears are fre...

show abstract

“…Since the majority of smear-positive, culture-negative specimens were scanty positive, it is possible that non-viable bacteria may have been detected on these specimens. The presence of smear-positive, culture-negative results has been reported in other studies[ 11 , 12 ], but it is not clear why this phenomenon was more frequent in non-IQA cohort in the study. The apparent disconnect between smear and culture conversion between the two patient cohorts remains unexplained and warrants further investigation in other settings.…”

Section: Discussionmentioning

confidence: 46%

Good Quality Locally Procured Drugs Can Be as Effective as Internationally Quality Assured Drugs in Treating Multi-Drug Resistant Tuberculosis

Qadeer¹,

Fatima²,

Fielding

et al. 2015

PLoS ONE

View full text Add to dashboard Cite

BackgroundOwing toGiven the high costs of drugs to treat multi-drug resistant tuberculosis (MDR-TB), the Green Light Committee (GLC) initiative enables TB programs to procure quality-assured drugs at reduced prices. Despite price reductions, internationally quality assured (IQA) drugs can be more expensive than locally procured drugs. There is little evidence to inform decision-makers about whether IQA drugs are more effective than local drugs. This is the first study to compare outcomes between MDR-TB patients treated using IQA, and locally procured drugs in the same hospitals during the same time period.Methods/FindingsA retrospective cohort study was conducted in three hospitals across Pakistan. Data on baseline characteristics and treatment outcomes during the first six months of treatment were extracted from hospital records of adult culture-positive pulmonary MDR-TB patients starting treatment between January 2011 and June 2012. Two cohorts were defined: patients receiving IQA drugs, and patients receiving locally procured non-IQA drugs. Data were analysed using Kaplan-Meier curves and Cox proportional hazards regression. The primary outcome compared between cohorts was time to culture conversion. Of 231 patients, 90 were in the IQA and 141 in the non-IQA cohorts. Baseline characteristics were similar except for higher frequency of quinolone resistance in the IQA cohort. Overall, 193 patients (84%) culture converted. Culture conversion was not faster in the IQA cohort; the median time was 81 and 68 days in the IQA and non-IQA cohorts, respectively. Unadjusted and adjusted hazard ratios for culture conversion in IQA verses non-IQA cohorts were 0.82 (95%-CI, 0.62-1.10) and 0.95 (95%-CI, 0.66-1.36) respectively.ConclusionsUse of good quality, locally procured drugs can be effective in treating MDR-TB, may involve lower costs than using IQA drugs and could strengthen developing country drug quality assurance systems. This may be a suitable alternative in lieu of or whilst awaiting arrival of internationally procured medicines.

show abstract

The Incidence and Clinical Implication of Sputum with Positive Acid-Fast Bacilli Smear But Negative in Mycobacterial Culture in a Tertiary Referral Hospital in South Korea

Cited by 27 publications

References 18 publications

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis

Good Quality Locally Procured Drugs Can Be as Effective as Internationally Quality Assured Drugs in Treating Multi-Drug Resistant Tuberculosis

Contact Info

Product

Resources

About