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Is frontloaded sputum microscopy an option in active tuberculosis case finding?

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Microscopy Diagnostics

Background:

  • Active tuberculosis (TB) case finding (ACF) is crucial for controlling TB transmission.
  • Light-emitting diode fluorescence microscopy (FM) is a key diagnostic tool in ACF programs.
  • Optimizing sputum collection and testing strategies is essential for maximizing diagnostic yield.

Purpose of the Study:

  • To evaluate the smear-positive yield of same-day (frontloaded) smear microscopy within an ACF program.
  • To compare the diagnostic performance of spot-spot (SS) versus spot-morning (SM) sputum collection approaches.
  • To determine the proportion of TB cases missed by different frontloaded microscopy strategies.

Main Methods:

  • A study was conducted in Phnom Penh, Cambodia, involving presumptive TB patients undergoing ACF.
  • Three sputum specimens were collected: two spot samples on Day 1 and one morning sample on Day 2 (spot-spot-morning, SSM).
  • Smears were analyzed using FM by blinded technicians, comparing SS and SM approaches to SSM results.

Main Results:

  • Out of 3306 patients providing three sputum samples, 188 (6.4%) were smear-positive using the SSM approach.
  • The spot-morning (SM) approach detected 177 cases, while the spot-spot (SS) approach detected 160 cases.
  • The SS approach would have missed 14.9% of smear-positive TB cases, significantly more than the SM approach (5.9%).

Conclusions:

  • Frontloaded sputum microscopy in ACF has a lower smear-positive yield compared to optimized strategies.
  • The spot-spot (SS) approach significantly underestimates the burden of smear-positive TB compared to the spot-morning (SM) approach.
  • Implementing the SM strategy is recommended to improve TB case detection in ACF programs.