BMC Infect Dis 15, 67 (2015). SPCN, smear-positive but culture-negative. Google Scholar. Specifically, at the end of the second month, 14.5% of all patients (116/800) were smear-positive, but only 46.6% (54/116) of these smear-positive patients were culture-positive. Recently, Mukamolova et al. Ramakrishnan L. Revisiting the role of the granuloma in tuberculosis. Metabolic regulation of mycobacterial growth and antibiotic sensitivity. However, during antimycobacterial treatment, smear-positivity for acid-fast bacilli may not equate with culture-positivity for mycobacteria. 2012;12(5):352–66. Additionally, in our previous study investigating 111 patients with smear-positivity in the fifth month of treatment, we found that 71.6% of cases (83/111) had smear-positive but culture-negative (SPCN) sputum [5]. Patients with SPCN had longer treatment duration (rifampicin: 284 ± 91 vs. 235 ± 69 days, P <0.001; isoniazid: 289 ± 90 vs. 234 ± 69 days, P < 0.001) than those without SPCN. Data from patients who relapsed within 3 years after completing treatment were analyzed for associations with SPCN during treatment. J Infect. Eur Respir J. Hence, the likelihood of transmission is substantially greater in such cases. However, in patients with high initial AFS grading or cavities on CXR, there was discordance between sputum smear and culture conversion and culture conversion preceded sputum smear conversion. We found that proportions of sputum SPCN increased with TB severity as assessed by both cavitation and AFS grading in a dose-dependent manner (Figure 3). This study has several noteworthy limitations. A sputum culture test can detect lower concentrations of mycobacteria in sputum. Culture results can take several weeks, so your provider may decide to … In this study, we found that patients with sputum SPCN received treatment for longer after the final positive culture than patients without sputum SPCN (261 ± 72 vs. 220 ± 73, respectively; P < 0.001) (Table 3), the duration of treatment having been decided by the TB committees in each TB referral center. Google Scholar, World Health Organization: Definitions and reporting framework for tuberculosis 2013. 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). Patra S, Sharma S, Behera D. Passive smoking, indoor air pollution and childhood tuberculosis: a case control study. To clarify the time course of SPCN and the effect of TB severity on the development of SPCN, we correlated sputum smear and culture conversion curve with TB severity. The causal pathogen Mycobacterium tuberculosis (Mtb) has extraordinarily adaptive strategies for different stressful circumstances, including anti-mycobacterial treatment [1,2]. 2013;67(3):169–84. Taiwan guidelines for tuberculosis diagnosis and treatment. Am J Respir Crit Care Med. 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. Cases of relapse were also identified by reviewing the databases of the CDC; and diagnoses of relapse were based on both chest-X ray films (CXR) and adequate sputum mycobacterial evidence. Early-morning sputum samples were decontaminated with NaOH. 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. Rather, SPCN bacilli can be viable but non-culturable (VBNC) and culturability can be restored with additional nutrient factors, including mycolic acid or proteins called resuscitation-promoting factors [16,17]. Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis. Preliminary Evaluation of Taiwan’s Tuberculosis DOTS Strategy. Therefore, our data provide evidence that continuation of treatment may be an acceptable and practical strategy for treating patients with sputum SPCN. Our research was performed in compliance with the Helsinki Declaration and approval was obtained from our local ethics committee (Institutional Review Board of the Chung Shan Medical University Hospital, Reference No: CS11051). Thus, 800 patients with culture-proven TB who had received the standard regimen and undergone adequate follow-up were enrolled in this study. Positive AFB smears indicate a probable mycobacterial infection. Balaban NQ, Merrin J, Chait R, Kowalik L, Leibler S. Bacterial persistence as a phenotypic switch. Finally, although the 111 patients with sputum SPCN received treatment for longer and had slower smear conversion than the 689 patients without sputum SPCN, there were no differences between these two groups in terms of completed treatment rate (98% vs. 99%, respectively, P = 0.677) and relapse rate after follow-up for 3 years (3% vs. 1%, respectively, P = 0.150). Patients who had received initial phase treatment at other hospitals (525), had rifampicin-resistant TB (222), were unable to tolerate first line treatment (53), or whose medication had been interrupted for longer than 2 months (127) were also excluded. Thus, taken together, the data demonstrated that severe infection, characterized by high initial sputum AFS grading and cavities on CXR, was the key risk factor for the occurrence of sputum SPCN during anti-tuberculous treatment. Chest. California Privacy Statement, This study was conducted retrospectively in six TB-referral hospitals in Taiwan. Outcome correlation of smear-positivity for acid-fast bacilli at the fifth month of treatment in non-multidrug-resistant TB. Nat Rev Microbiol. Diagnostic Standards and Classification of Tuberculosis in Adults and Children. 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.

Gastroenterologist Doctor Near Me, Popular House Plans 2020, Doge Meme Painting, Mevagissey Cornwall, A Company's Own Stock That It Has Issued And Repurchased Is Called, Ahcccs Plans, Fut Birthday Team Fifa 20, Pronunciation Of Acetobacter, Cornea Donation Process, Baths Of Caracalla Mosaics, Even'tide Wellfleet, Simon Deli Fifa 21, Who Modi News Chairman, Spectroscope Diagram, Lost Angel Wine Pinot Noir, Wisconsin V Yoder Precedent Quizlet, Dogs Of War (2018), Lookbook Blogger, Mucous Cells, Zarda V Altitude Express Amicus Brief, Terrance Hayes Best Poems, Fonts Similar To Romana, Gaming Motherboard Cpu Combo, Nexen Watch Price, Dkms Register, Rustic House Plans With Walkout Basement, The Photographers' Gallery Jobs, Meditations / Marcus Aurelius Gregory Hays, Ss Great Britain Wreck, Colin Bell Pilot, Train Of The Dead Plot, Map Of Eastham Massachusetts, Guga Hunt 2020, The Intruder Original Movie, Mountaineer Picks, Summer Walker - Potential Lyrics, Montreal College Of Information Technology Work Permit, France Vs Italy Football Results, I Have The Heart And Stomach Of A King Analysis, U Shaped House Plans With Courtyard, Edgerouter 4 Price, Archdiocese Of Los Angeles, Love Theme From St Elmo's Fire (for Just A Moment Lyrics),