Importance of sputum

collection in follow-up in
•
TB
Sputum smear examination by direct
microscopy is the method of choice
for finding and defining various stages
of pulmonary tuberculosis.
• The number of bacilli seen in a
smear reflects the disease severity
and patient infectivity.
•Pt. is declared +ve when there are at
least 10,000 organisms present per ml
of sputum and the value is dependent
on immune status of the pt.
 Slide reporting
Number of bacilli Result reported

No AFB per 100 oil immersion fields 0

1-9 AFB per 100 oil immersion fields Scanty

10-99 AFB per 100 oil immersion fields + (1+)

1-10 AFB per oil immersion field ++ (2+)

>10 AFB per oil immersion field +++ (3+)

 Defining cases during
follow-up on basis of
sputum examination.
 Smear positive TB- At least 2 initial
sputum smears positive for
AFB culture or 1 +ve smear and 1 +ve
culture.
 Smear negative TB- At least 3
negative smears but TB suggestive
symptoms and positive culture. (+ve
culture is gold standard for diagnosis)
Relapse- A pt. who returns smear
positive having previously been treated
Failure case- A pt. who was initially smear
positive, who began treatment and who
remained or became smear positive again at
5 months or later during the course of
treatment.
Return after default– a pt. who returns
sputum smear positive after having left
treatment for at least 2 months.
TREATMENT REGIMEN SPUTUM EXAMINATIONS FOR
PULMONARY TB
Cat. Type of patient Pre Test at If THEN :
of treatmen month resul
treat t sputum t is

Cate New smear sputum + 2 - Start continuation phase, test

sputum at 4, 6 months
gory +ve
Continue intensive phase for 1
I + more month

Seriously ill smear -ve - 2 - Start continuation phase, test

sputum at 6 months
Continue intensive phase for 1
+ more month, test sputum at
3,4,7 months

Cate Relapse, failure or + 3 - Start continuation phase for 1

more month, test sputum at
gory default 4,6,9 months.
II Continue intensive phase for 1
+ more month, test sputum at
4,6,9 months

Cate New smear –ve not - 2 - Start continuation phase, test

sputum at 6 months
gory seriously ill
Re-register the pt. and begin cat
III II treatment
+
  Examples of seriously ill pulmonary TB
cases are meningitis, disseminated TB,
tuberculosis pericarditis, peritonitis,
bilateral or extensive pluerisy, spinal TB
with neurological complications and
intestinal and genito-urinary TB.
 In rare cases, smear –ve pt. or those with
extra-pulmonary disease can have relapse
or failure, diagnosis of which is supported
by culture or histological evidence of
current active TB. In these cases the pt.
should be given category II treatment
 Any pt. treated with Cat I or Cat III who
has a +ve smear at 5,6,7 month of
treatment should be considered a failure
and started on cat II treatment afresh.