Google Scholar. This study was conducted retrospectively in six TB-referral hospitals in Taiwan. Cookies policy. The percentage of patients with culture positivity was similarly low between the two groups after treatment for 5 months (0.9%, 1/111 vs. 2.0%, 14/689; P = 0.707); however, even after treatment for 9 months the percentage of patients with smear positivity remained higher in patients with sputum SPCN than in those without it (5.4%, 6/111 vs. 0.6%, 4/689, respectively; P = 0.001). Patients with sputum SPCN clearly had more severe TB than those without sputum SPCN, as evidenced by the former being more likely to have cavitated lesions (65% vs. 31%, P < 0.001) and large cavities (>4 cm) (42% vs. 14%, P < 0.001) on CXRs as well as higher sputum AFS grading than patients without sputum SPCN. A smear negative sample may still grow mycobacteria since the culture media allows low numbers of bacteria to multiply and be detected. Nat Rev Microbiol. Most bronchial washings specimens sent to our microbiology laboratory are smear positive, culture positive, but some are smear negative, culture positive. Taiwan Centers for Disease Control. BMC Infect Dis 15, 67 (2015). The authors declare that they have no financial or commercial conflicts of interest with regards to this submission. We have shown that severe TB infection, as evidenced by cavitation on CXR and high AFS grading in sputum, is the critical risk factor; smoking also contributes to the occurrence of sputum SPCN. Pefura-Yone EW, Kengne AP, Kuaban C. Non-conversion of sputum culture among patients with smear positive pulmonary tuberculosis in Cameroon: a prospective cohort study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The data regarding relapsed cases are summarized in Table 4. 2004;305(5690):1622–5. Article  The remaining 436 (82.26%) of 530 samples were smear-positive culture-positive and so were not included in this analysis.

BMC Infectious Diseases

We therefore surmised that sputum SPCN may be a clinical indicator of host-pathogen interactions in the lungs during TB infection. Categorical variables were compared using the χ2 test and differences in continuous variables were analyzed using the Mann–Whitney U test.

https://doi.org/10.1186/s12879-015-0795-1, DOI: https://doi.org/10.1186/s12879-015-0795-1. Smear positive/Culture negative By Juma Khudonazarov | 03 Mar, 2012 . Taiwan Epidemiol Bull. On univariate analysis, the statistical power for cavitated lesions (P < 0.001), AFS grading (P < 0.001), and smoking (P < 0.001) were stronger than for maleness (P = 0.033), alcohol consumption (P = 0.008), and type 2 diabetes mellitus (P = 0.003), which may explain why subsequent multivariate analysis found that only cavitated lesions, AFS grading, and smoking predicted development of SPCN.

The Cochran–Armitage trend test was used to assess differences in trends in acid-fast smear (AFS) grading and cavity size in patients with or without sputum SPCN. Int J Tuberc Lung Dis. Finally, the rate of relapse within 3 years of completing treatment was similar for groups with/without SPCN (2.7%, 3/111 vs. 1.0%, 7/689, respectively; P = 0.15). Chest.
American Thoracic Society and the Centers for Disease Control and Prevention. volume 15, Article number: 67 (2015) A sputum culture test can detect lower concentrations of mycobacteria in sputum. These were high initial acid-fast stain grading (>1+) (OR, 3.407; 95% CI, 2.090–5.553), cavities on CXR (OR, 2.217; 95% CI, 1.359–3.615), and smoking (OR, 1.609; 95% CI, 1.006–2.841).

Preliminary Evaluation of Taiwan’s Tuberculosis DOTS Strategy. Culture results can take several weeks, so your provider may decide to …

Ting-Fang Wang RJ. An AFB smear could also be falsely positive if you are taking antibiotics for a mycobacterial infection. 2011;9(5):e1001065. To further investigate the clinical impact of sputum SPCN, we assessed treatment regimens, outcomes, and relapse rate during the 3-year follow-up after completing treatment (Table 3) and found that the 111 patients with sputum SPCN received treatment for longer than the 689 without sputum SPCN. Baek SH, Li AH, Sassetti CM. In accordance with the tuberculosis treatment guidelines in Taiwan [13], all patients’ sputum smears and cultures had been checked in the second and fifth months after initiation of treatment; monthly sputum checks had also been performed until sputum conversion in all patients with positive smears.

PubMed Google Scholar. Google Scholar. If your results on an AFB smear or culture were negative, you probably don't have active TB. Therefore, the strong correlation between cavitation and the occurrence of SPCN mycobacteria indicates that caseous granulomas, which contain numerous Mtb released from dead macrophages, may be the major source of SPCN mycobacteria.

used culture medium with and without resuscitation-promoting factors and demonstrated not only the presence of VBNC Mtb but also an increased proportion of VBNC Mtb during treatment of pulmonary TB infection [18]. 2013;67(3):169–84. CAS  Cumulative percentages of positive sputum mycobacterial smear (solid line) and positive sputum mycobacterial culture (dotted line) in patients with low (≤1+) and high acid-fast stain grading (>1+) at the start of treatment (A), and patients with and without cavity formation on chest-X ray films (B). 2011;37(2):376–83. Mukamolova GV, Turapov O, Malkin J, Woltmann G, Barer MR. Resuscitation-promoting factors reveal an occult population of tubercle Bacilli in Sputum. However, more studies are needed to establish the best treatment regimen for these patients. Outcome correlation of smear-positivity for acid-fast bacilli at the fifth month of treatment in non-multidrug-resistant TB. Outcome correlation of smear-positivity but culture-negativity during standard anti-tuberculosis treatment in Taiwan. 2014;14:138. Second, the standard decontamination procedures in sputum processing can decrease culturability.

2012;12(5):352–66. 2006;4(7):556–62. The medical records of enrolled patients were reviewed to obtain data on associated medical conditions, laboratory findings, hemoglobin A1C at the start of anti-TB treatment, serial sputum results, treatment regimen, and outcomes.

Importantly, the three patients who relapsed with sputum SPCN during initial treatment did not develop any new drug resistance. Cite this article. Ziehl–Nielsen stained smears were examined and graded according to the American Thoracic Society guidelines [11]. Patients were excluded if the TB diagnosis had been revised (439), there was no mycobacterial evidence of TB (981), or they had an inadequate duration of follow-up resulting from being transferred out (306) or dying within the initial 2 months (399). Nat Rev Immunol. All 24 culture-positive sputum specimens (14 positive for AFB and 10 negative for AFB) were positive by PCR for M. tuberculosis DNA on eluates from the smears, and correspondingly, all 23 culture-negative sputum specimens (negative for AFB) were negative by PCR with eluates from the smear. All data were analyzed using SPSS version 16.0 (SPSS, Chicago, IL, USA). 2000;161(4 Pt 1):1376–95. Sputum SPCN was defined as sputum that was smear-positive for acid-fast bacilli but did not yield any mycobacteria on either liquid or solid media. PLoS Biol. J Exp Med. Our data show that sputum SPCN mostly develops 157 ± 95 days after the start of treatment. In patients with low initial AFS grading or no cavities on CXRs, the sputum smear conversion and culture conversion curves were close to each other and sputum smear conversion mostly preceded sputum culture conversion (Figure 2).

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