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Tuberculosis in the Torres Strait: the lady doth test too much
J'Belle Foster1, Ben Marais2, Rotona L Martin3
1College of Medicine and Dentistry and Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, Qld 4811, Australia jbelle.foster@health.qld.gov.au.
Rural and Remote Health
|February 10, 2021
Summary
Two sputum specimens are sufficient for diagnosing pulmonary tuberculosis (PTB), reducing delays in treatment. A third sputum specimen is only necessary if initial tests are negative and symptoms persist.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Pulmonary tuberculosis (PTB) diagnosis requires prompt action to prevent transmission.
- Current guidelines in the Torres Strait Islands recommend three sputum specimens, often delaying treatment initiation.
Purpose of the Study:
- To evaluate the diagnostic yield of sputum specimens for PTB in the Torres Strait Islands.
- To determine the optimal number of sputum specimens for accurate PTB diagnosis.
Main Methods:
- Retrospective analysis of PTB cases diagnosed between 2000 and 2018.
- Assessment of diagnostic yield and incremental yield of sputum specimens.
- Binary logistic regression to identify factors associated with smear-positive results.
Main Results:
- Acid-fast bacilli (AFB) were detected in the first or second sputum specimen for 97% of smear-positive PTB cases.
- 18% of collected sputum samples were of poor quality, significantly associated with smear-negative results.
- Papua New Guinea nationals had a higher likelihood of smear-positive results compared to Australian-born patients.
Conclusions:
- Two high-quality sputum specimens provide adequate diagnostic yield for PTB.
- A third specimen is recommended only for patients with persistent symptoms and two negative results.
- Decentralized Xpert Ultra testing is ideal for remote settings like the Torres Strait Islands, especially for drug-resistant TB.
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