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    Jan 23, 2021
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    Reducing the Number of Sputum Samples Examined and Thresholds for Positivity: An Opportunity to Optimise Smear Microscopy.

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    Authors
    Bonnet, M
    Ramsay, A
    Gagnidze, L
    Githui, W
    Guerin, P J J
    Varaine, F
    Affiliation
    Epicentre, Paris, France. maryline.bonnet@geneva.msf.org
    Issue Date
    2007-09
    
    Metadata
    Show full item record
    Journal
    International Journal of Tuberculosis and Lung Disease
    Abstract
    SETTING: Urban health clinic, Nairobi. OBJECTIVE: To evaluate the impact on tuberculosis (TB) case detection and laboratory workload of reducing the number of sputum smears examined and thresholds for diagnosing positive smears and positive cases. DESIGN: In this prospective study, three Ziehl-Neelsen stained sputum smears from consecutive pulmonary TB suspects were examined blind. The standard approach (A), > or = 2 positive smears out of 3, using a cut-off of 10 acid-fast bacilli (AFB)/100 high-power fields (HPF), was compared with approaches B, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3, one of which is > or = 10 AFB/100 HPF; C, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3; D, > or = 1 positive smear (> or = 10 AFB/100 HPF) out of 2; and E, > or = 1 positive smear (> or = 4 AFB/100 HPF) out of 2. The microscopy gold standard was detection of at least one positive smear (> or = 4 AFB/100 HPF) out of 3. RESULTS: Among 644 TB suspects, the alternative approaches detected from 114 (17.7%) (approach B) to 123 cases (19.1%) (approach E) compared to 105 cases (16.3%) for approach A (P < 0.005). Sensitivity ranged between 82.0% (105/128) for A and 96.1% (123/128) for E. The single positive smear approaches reduced the number of smears by 36% compared to approach A. CONCLUSION: Reducing the number of specimens and the positivity threshold to define a positive case increased the sensitivity of microscopy and reduced laboratory workload.
    Publisher
    International Union Against TB and Lung Disease
    URI
    http://hdl.handle.net/10144/20674
    PubMed ID
    17705971
    Additional Links
    http://www.ingentaconnect.com/content/iuatld/ijtld
    Language
    en
    ISSN
    1027-3719
    Collections
    Laboratory
    TB

    entitlement

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