title: Predicting results of mycobacterial culture on sputum smear reversion after anti-tuberculous treatment: a case control study.
abstract: BACKGROUND
  Little is currently known regarding sputum smear reversion (acid-fast smear becomes positive again after negative conversion) during anti-tuberculous treatment. This study aimed to evaluate its occurrence in patients with pulmonary tuberculosis (TB) and identify factors predicting results of mycobacterial culture for smear-reversion of sputum samples.
  
  
  METHODS
  The retrospective review was performed in a tertiary referral center and a local teaching hospital in Taiwan. From 2000 to 2007, patients with smear-positive culture-confirmed pulmonary TB experiencing smear reversion after 14 days of anti-tuberculous treatment were identified.
  
  
  RESULTS
  The 739 patients with smear-positive pulmonary TB had 74 (10%) episodes of sputum smear reversion that grew Mycobacterium tuberculosis in 22 (30%) (Mtb group). The remaining 52 episodes of culture-negative sputum samples were classified as the non-Mtb group. The anti-tuberculous regimen was modified after confirming smear reversion in 15 (20%). Fourteen episodes in the Mtb group and 15 in the non-Mtb group occurred during hospitalization. All were admitted to the negative-pressure rooms at the time of smear reversion. Statistical analysis showed that any TB drug resistance, smear reversion within the first two months of treatment or before culture conversion, and the absence of radiographic improvement before smear reversion were associated with the Mtb group. None of the smear reversion was due to viable M. tuberculosis if none of the four factors were present.
  
  
  CONCLUSIONS
  Sputum smear reversion develops in 10% of patients with smear-positive pulmonary TB, with 30% due to viable M. tuberculosis bacilli. Isolation and regimen modification may not be necessary for all drug-susceptible patients who already have radiographic improvement and develop smear reversion after two months of treatment or after sputum culture conversion.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Lee
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Lee
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000166:cytology / Q000302:isolation & purification*; D013902:Radiography, Thoracic; D012008:Recurrence; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D013624:Taiwan; D014376:Tuberculosis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology
chemical_list: D000995:Antitubercular Agents