title: A minimum 5.0 ml of sputum improves the sensitivity of acid-fast smear for Mycobacterium tuberculosis.
abstract: Detection of acid-fast bacilli (AFB) by sputum smear supports treatment decisions with pulmonary tuberculosis (TB), but smear sensitivity for Mycobacterium tuberculosis is only approximately 45 to 75%. In an effort to increase sensitivity, smears were prepared using a minimum sputum volume of 5.0 ml. Sensitivity of smears during a 39-mo period (n = 1,849) using >/= 5.0 ml of sputum was 92. 0%, significantly greater (p < 0.001) than a sensitivity of 72.5% in a previous 24-mo period (n = 3,486) when all specimens were processed regardless of volume. All new cases of TB (n = 18) were smear-positive with >/= 5.0 ml of sputum before treatment, and all were receiving antituberculosis drugs at hospital discharge. In contrast, significantly fewer new cases of TB (14 of 26, p = 0.002) were positive before treatment when smears were prepared using sputum of any volume, and significantly fewer of these new TB cases (18 of 26, p = 0.03) were receiving treatment at hospital discharge. The eight cases without treatment were smear-negative. These results indicate that acid-fast smear using >/= 5.0 ml of sputum increases sensitivity for M. tuberculosis and accelerates treatment of TB.
authors.affiliation: Department of Pathology and Medicine, Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, Illinois, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Warren
authors.forename: M
authors.initials: M
authors.lastname: Bhattacharya
authors.forename: K N
authors.initials: KN
authors.lastname: De Almeida
authors.forename: K
authors.initials: K
authors.lastname: Trakas
authors.forename: L R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D001431:Bacteriological Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000254:growth & development / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D013194:Staining and Labeling; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology*