Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis

Mota, Patrícia Caetano; Carvalho, Aurora; Valente, Iacopo; Braga, Rosana Teresinha Vaccare; Duarte, Raquel

doi:10.1016/j.rppnen.2012.01.004

Cited by 25 publications

(28 citation statements)

References 22 publications

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“…Higher bacillary load at diagnosis has consistently been associated with delayed smear conversion at 2 months, 10,11,[14][15][16][17]20 as suggested by the higher sputum smear grades observed among delayed converters in our study. Other factors associated with delayed sputum smear conversion that we were unable to demonstrate include evidence of cavitation on chest X-ray, 11,13,14,19 age at diagnosis, 11,13,16,19 location of health facility, 15,21 sex 12,16 and treatment with non-standardised regimens or missed doses of anti-tuberculosis drugs. 10,14 In Vanuatu, delayed conversion occurred despite good treatment adherence and in the absence of drug resistance.…”

Section: Public Health Actionsupporting

confidence: 63%

“…Studies from various countries reported non-conversion rates of 5-32%. [10][11][12][13][14][15][16][17][18][19] No drug-resistant TB cases were detected, although this might be an important consideration in other settings. Higher bacillary load at diagnosis has consistently been associated with delayed smear conversion at 2 months, 10,11,[14][15][16][17]20 as suggested by the higher sputum smear grades observed among delayed converters in our study.…”

Section: Public Health Actionmentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17][18][19] No drug-resistant TB cases were detected, although this might be an important consideration in other settings. Higher bacillary load at diagnosis has consistently been associated with delayed smear conversion at 2 months, 10,11,[14][15][16][17]20 as suggested by the higher sputum smear grades observed among delayed converters in our study. Other factors associated with delayed sputum smear conversion that we were unable to demonstrate include evidence of cavitation on chest X-ray, 11,13,14,19 age at diagnosis, 11,13,16,19 location of health facility, 15,21 sex 12,16 and treatment with non-standardised regimens or missed doses of anti-tuberculosis drugs.…”

Section: Public Health Actionmentioning

confidence: 99%

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Profile of tuberculosis patients with delayed sputum smear conversion in the Pacific island of Vanuatu

Fanai

Viney

Tarivonda

et al. 2014

public health action

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Global implementation of the DOTS strategy has resulted in a decline in tuberculosis (TB) incidence rates. 1 However, total patient numbers have not declined, and rates remain high in areas affected by human immunodeficiency virus (HIV) infection, poverty and drug-resistant TB. 2 Despite the adoption of the DOTS strategy in 1999-2000, progress towards global TB control targets has been slow in the Pacific region, with 16 534 cases (165 per 100 000 population) notified in 2011 compared to 4017 (68/100 000) in 1990. 1 TB remains a major public health threat in the region. The risk of Mycobacterium tuberculosis transmission is elevated in islands with a high population density, while vulnerability to developing TB is affected on one hand by malnutrition and food insecurity and on the other by rising rates of diabetes. 3 There has been growing concern over the possible emergence of drug-resistant TB in the Pacific. To date, 11 Pacific Island countries and territories have reported cases of multidrug-resistant TB (MDR-TB), but no formal prevalence surveys have been conducted. 1 A Pacific-wide supranational laboratory referral system was established in 2004 to provide ongoing surveillance for drug-resistant TB. 4 The Pacific TB laboratory (PATLAB) network links countries to reference laboratories where M. tuberculosis confirmation, strain typing and comprehensive drug susceptibility testing (DST) can be performed.Delayed sputum smear conversion has been identified as a risk factor for TB treatment failure and drug-resistant TB, 5,6 and may indicate prolonged infectiousness. Sputum smear status is typically recorded at the end of the intensive phase of treatment (i.e., after 2 months), and patients who still have smear-positive sputum at this time are regarded as delayed converters. In Vanuatu, there has been concern that TB incidence rates are not declining as expected and that increasing numbers of sputum smear-positive TB patients fail to convert to smear-negative within 2 months of treatment. However, the frequency of sputum non-conversion at 2 months and the profile of these patients have not been established.In the present study, we aimed to assess TB trends, compare the characteristics of 2-month non-converters (delayed converters) with those of converters and assess the potential contribution of drug-resistant TB. METHODS Study designThis retrospective cohort study included all sputum smear-positive TB cases who remained sputum smear-positive after 2 months of anti-tuberculosis treatment over a 9-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). For logistical reasons, 2-month sputum non-converters (delayed converters) were compared with those with smear conversion at 2 months (converters) diagnosed during 2011-2012. Results of specimens sent to the Supranational Reference Laboratory (SRL; Queensland Mycobacterium Reference Laboratory) in Brisbane, QLD, Australia, were reviewed to assess for drug-resistant TB. Study settingThe study was conducted in the Republic of Vanuatu, a Pacific Island na...

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Section: Public Health Actionsupporting

confidence: 63%

Section: Public Health Actionmentioning

confidence: 99%

Section: Public Health Actionmentioning

confidence: 99%

See 1 more Smart Citation

Profile of tuberculosis patients with delayed sputum smear conversion in the Pacific island of Vanuatu

Fanai

Viney

Tarivonda

et al. 2014

public health action

View full text Add to dashboard Cite

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“…All continuous variables were summarized as medians with interquartile range while the categorical variables were expressed as proportions with percentages. In this study, patients who had their follow-up sputum positive after intensive phase were coded as having delayed sputum conversion as used in other studies [9, 12]. The proportion of patients with delayed sputum conversion was calculated and logistic regression model was performed to determine the odds ratio and 95% CI to find out the degree of association between the outcome of interest and its potential risk factors.…”

Section: Methodsmentioning

confidence: 99%

“…Early diagnosis and prompt treatment initiation of smear positive patients are an important strategy with a goal line of smear conversion at two months of intensive phase of potent antituberculous [8]. While sputum conversion at the end of the intensive phase is regarded as an important predictor of treatment success, a significant proportion of patients on antituberculous remain positive at the end of intensive phase with some places reporting a prevalence that is in excess of 25% [9]. These patients are additionally at a high risk of developing multidrug resistance (MDR), which is a very challenging phenomenon in TB treatment [10].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study

Gunda

Nkandala

Kavishe

et al. 2017

Journal of Tropical Medicine

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Introduction Smear positive TB carries high morbidity and mortality. The TB treatment aims at sputum conversion by two months of antituberculous. Patients who delay sputum conversion remain potentially infectious, with risk of treatment failure, drug resistance, and mortality. Little is known about the magnitude of this problem in our setting. This study was designed to determine the prevalence and risk factors of delayed sputum conversion in northwestern rural part of Tanzania. Methods This was a retrospective cohort study involving smear positive TB patients at Sengerema DDH in 2015. Demographic data, HIV status, and sputum results at TB diagnosis and on TB treatment were collected and analyzed using STATA 11. Results In total, 156 patients were studied. Males were 97 (62%); the median age was 39 [30–51] years. Fifty-five (35.3%) patients were HIV coinfected and 13 (8.3%) patients had delayed sputum conversion which was strongly associated with male gender (OR = 8.2, p = 0.046), age >50 years (OR = 6.7, p = 0.003), and AFB 3+ (OR = 8.1, p = 0.008). Conclusions Delayed sputum conversion is prevalent in this study. These patients can potentially fail on treatment, develop drug resistance, and continue spreading TB. Strategies to reduce the rate of delayed sputum conversion could also reduce these potential unfavorable outcomes.

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The Cavity as a Lasting Abode for Tuberculous Bacilli

Jawad

Jafri

Saifullah

et al. 2022

SN Compr. Clin. Med.

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The aim of this study was to determine the factors associated with persistent sputum positivity at the end of 2 months of treatment in patients presenting with (drug-susceptible) pulmonary tuberculosis at a tertiary care hospital in Karachi. A cross-sectional study was conducted at the Department of Chest Medicine (Ward 12), Jinnah Postgraduate Medical Center (JPMC), Karachi, over 6 months. A sample of 73 consenting, newly diagnosed, smear-positive drug-susceptible pulmonary tuberculosis patients was studied. Demographic (age, gender, height, weight and duration of tuberculosis, BMI, socioeconomic, occupational, marital, educational and residential statuses) and clinical factors (chest X-ray extent and cavities, initial smear results, diabetic and smoking statuses) which may be associated with sputum non-conversion were entered in a proforma. Patients were followed up at 2 months of treatment with a sputum smear. Data analysis was done on SPSS (Statistical Package for Social Sciences-version 20.0). Rate of sputum positivity after 2 months of anti-tubercular drug treatment was 17.8%. None of the above-mentioned demographic and clinical factors was associated with persistence of sputum positivity except for the presence of CXR cavities, which made it 5.5 times more likely that the patient would remain smear-positive at 2 months ( p = 0.035). The finding of chest radiograph cavities makes it highly likely that a pulmonary tuberculosis patient may remain infectious or have an unfavorable outcome despite taking treatment for 2 months. Clinicians and national policy-makers should thus bear in mind the implications this can have with regard to disease control and therefore pay particular attention to such patients in terms of stringent monitoring and directly observed treatment short-course (DOTS) provision. Supplementary Information The online version contains supplementary material available at 10.1007/s42399-021-01098-6.

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Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis

Cited by 25 publications

References 22 publications

Profile of tuberculosis patients with delayed sputum smear conversion in the Pacific island of Vanuatu

Profile of tuberculosis patients with delayed sputum smear conversion in the Pacific island of Vanuatu

Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study

The Cavity as a Lasting Abode for Tuberculous Bacilli

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