Increased yield of smear positive pulmonary TB cases by screening patients with >2 weeks cough, compared to >3 weeks and adequacy of 2 sputum smear examinations for diagnosis

摘要

BackgroundudRNTCP recommends examining three sputum smears for AFB from Chest Symptomatics (CSs) with cough of >3 weeksudfor diagnosis of Pulmonary TB (PTB). A previous multi-centric study from Tuberculosis Research centre (TRC) hasudshown that the yield of sputum positive cases can be increased if duration of cough for screening was reduced to >2 weeks.udOther studies have shown that two smear examinations are adequate for diagnosis of smear positive PTB . To validate theudabove findings, a cross sectional multi-centric study was repeated in different settings in five geographical areas in India.udMethodsudThree primary and secondary level health facilities with high out-patient attendance were selected from two TuberculosisudUnits (TU) in each of the 15 selected districts to screen about 10,000 new adult outpatients from each state. For patientsudwho did not volunteer history of cough, symptoms were elicited using a structured simple questionnaire. All the CSs wereudreferred for sputum examination.udResultsudA total of 96,787 out-patients were registered. Among them 69,209 (72%) were new adult out-patients. Using >2 weeksudof cough instead of > 3 weeks as the criterion for screening, there was an overall increase of 58% in CS and 23% increaseudin the detection of smear-positive cases. Among 211 patients, 210 were positive at least by one smear from the initialudtwo specimens. Increase in the work-load if 2 smears were done for patients with cough of >2 weeks cough were 2udspecimens (i.e.13 to 15) per day for an adult OPD of 150.udConclusionudThe yield of sputum positive PTB cases can be improved by screening patients with >2 weeks cough and two specimensudare adequate for diagnosis.