|VALUE OF SPUTUM EXAMINATION IN PREDICTING PROGNOSIS
DURING SHORT COURSE CHEMOTHERAPY
|Sujatha Chandrasekaran, R Rajalakshmi & P Jagota:
NTI Bulletin 1993, 29, 41-44.
Culture examination of sputum is known to be the
best tool for assessing the prognosis of pulmonary tuberculosis
patients. Controlled clinical trials with Short Course Chemotherapy
(SCC) have shown that culture examination of sputum at the end of
two months elicited a high degree of conversion, while smear results
were inferior due to presence of dead organisms in the sputum. But,
it is not possible to provide sputum culture facilities in the District
TB Programme (DTP). Since smear examination facilities is widely
available under the DTP, this paper examines the comparability of
smear results with culture in patients treated with SCC. It also
examines the value if any, of an early evaluation of the treatment
outcome with SCC under operational conditions by doing smear examination
at two months. Data from two operational studies on SCC are utilised
for this purpose.
Of 256 total patients examined, 62 were smear positive
at the end of two months, but 41 of them were excreting non- viable
bacilli and were culture negative. Nevertheless, in predicting the
final outcome of chemotherapy, no significant difference was observed
between smear and culture examination at the end of two months.
Smear positivity at the end of 2 months, by itself, cannot be considered
to bode an unfavourable response, whereas negativity had a good
probability of a favourable response. Microscopy in SCC gave
as reliable a result as culture both during and at the end of chemotherapy.
Hence, a properly conducted smear examination is as good as culture
for diagnostic and prognostic purposes under operational conditions.
|KEY WORDS: SMEAR EXAMINATION, SCC, PREDICTIVE
VALUE, CONTROL PROGRAMME, FIELD CONDITIONS.