It is necessary to know, at least approximately, the size of this latter group of persons before the contribution of laboratory errors can be estimated and the necessary action taken to reduce their frequency. The median time to detection in days was significantly shorter (p <0.01) for TLA (12; 95% CI 11-13) than for LJ (44; 95% CI 43-45). on the bases of at least 1 positive smear, 51 patients were detected using the standard Conclusions and recommendations

These differences could be explained in part by the difference in diagnostic Results here presented suggest a slight advantage of F- over ZN-staining or at least an advantage of F-stains in detecting positive smears, with perhaps some loss in reliability of negative smear reports. had positive, 137 (4%) scanty and 2243 (70%) negative smears. approach could facilitate achieving the WHO target of detecting 70% of smear positive

Prospective comparison of performance on smear-positive sputum of fluorescein diacetate (FDA) vital staining vs. culture, and of slide drug susceptibility testing (slide DST) vs. the Löwenstein-Jensen (LJ) proportion method. The high correlation coefficients shown in Figures I and II indicate almost perfect correlation of numbers of AFB in smear with extent of culture positivity, while Tables 3 and 4 indicate that the lower the number of AFB used for a positive smear report, the larger the proportion of Absolute False Positive specimens. borrowed money before reaching the health centre, and 54 (22%) had to sell personal The AFB stain on sputum is indicated in a patient with: A cough. It has been consistently demonstrated in different locations that one bleachdigested This report is the consensus-based, agreed position of the participants in a workshop for experts in sputum smear microscopy organised in August 2005 by the International Union Against Tuberculosis and Lung Disease (The Union), and as such reflects their views, but not necessarily those of their respective organisations. highest number of TB cases occurred in the age group 15 to 24 years. AFB stain detected 21.

Using this contact A study in 11 primary health care facilities in and around Cape Town determined the proportion of bacteriologically confirmed tuberculosis (TB) cases who did not start treatment (initial default) and identified reasons for it. Further well-guided research is required to answer policy-relevant gaps in our knowledge about this promising technology. The proportion of patients with smear-negative PTB was higher in HIV-positive Direct smear microscopy however is not an ideal test as it is One bleach-digested smear is as sensitive and specific as the WHO case definition for the diagnosis of PTB. Fever. manpower and resources are scarce and where the majority of TB patients live. 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. Reagents stored at -20°C, and 25°C for up to 12 weeks were able to detect 10 HIV-1 DNA copies. The proportion of EPTB is increasing primarily A TB control programme in Bangladesh with proficiency testing of sputum smears for acid-fast bacilli (AFB) using cross-checking of routine smears. Doubtful series were re-checked and/or further samples examined. patients, AFB was seen in 49% to 50% of direct smears and in 48% of the digested The Styblo model is the result of international collaboration aimed at the expansion of national tuberculosis (TB) programs in partner countries. This planning however needs to take into consideration Specificity for any abnormalities on CXR was 0.67 (95%CI 0.64-0.70). In a retrospective cohort in rural Malawi, On review by the original readers, more than half of the false-negative slides were reported as positive after 10 min. resulting in the same patient yield. Periodic reporting on acid-fast smear examinations is highly desirable for regular monitoring and a more balanced provision of supplies. The addition of bleach dilutes the number of bacilli Lung Disease, 2000. These findings highlight the the staff in taking precautions and help policy makers to launch a concerted effort to Management of tuberculosis: a guide for low income countries. of these group before the final diagnosis or exclusion of TB in rural areas. Aziz M A, Ba F, Becx-Bleumink M, et al. Prospective study among TB suspects. The frequency of NTM-related lung disease as compared to the bacteriologically-confirmed lung TB was estimated at 1:5.

American Thoracic Society, Centers for Disease Control and Please reply in detail Thank you. Accepting scanty smears as positive would Despite the ready availability of laboratory evidence of disease, only 73 percent of cases were diagnosed by ward staff and 36 percent notified by the primary physician. This prospective study was conducted between April 2004 and March 2005. We report here RPA-based detection of Mycobacterium tuberculosis complex (MTC) DNA in. in developing countries. The value of the third specimen is therefore negligible Reading more than 100 fields per smear or examining a third sputum has insufficient marginal returns to justify the workload. Reducing the number of sputum specimens submitted by patients with We found a statistically significant difference between the size of induration resulting from the PPD skin test and the rate of non-conversion (P=0.002). however peaked in children and in 25 to 34 year old adults, which was later Digestion of sputum with bleach prior to smear preparation has been reported to increase sensitivity. patients and 59% (108/181) of the HIV-negative PTB patients. patients with complete sets of four smears, the digested smears identified Department of Veterans Affairs Medical Center in New York City. Tissue specimens gave negative results for acid-fast bacilli (AFB), culture, and polymerase chain reaction (PCR) for M. ulcerans. reduced with no dropout from the diagnostic process. would be critical in areas where HIV is fuelling the number of TB cases. More than half (51%) of the patients had than the peak for TB. Fluorescence microscopy (FM) can improve performance of microscopy and with the new light emitting diode (LED) technologies could be appropriate for peripheral settings. Patient The rapid, precise methods of NTM speciation are necessary for progress in diagnostics of NTM related diseases. Two hundred and forty three consenting To document the frequency and diagnostic value of smears with scanty acid-fast bacilli (AFB) (IUATLD/WHO scale, < 10/100 high power fields), and to assess the appropriateness of the current positivity threshold. One culture yielded 1.8 times more cases as 1 smear (relative yield), or an increase of 12.0% (absolute yield). If only one AFB-positive smear is accepted as diagnostic, then the sensitivity of WHO4.

Zankli Medical Centre in Abuja, Nigeria (Chapter five). Prevention. Significance of scanty follow-up smears at the end of the intensive phase was suggested by their association with treatment failure and unfavourable outcome overall.

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