title: An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda.
abstract: The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% (P < 0.001) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection.
authors.affiliation: Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda ; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda ; Iganga/Mayuge Demographic Surveillance Sites, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Willy
authors.initials: W
authors.lastname: Ssengooba
authors.forename: David P
authors.initials: DP
authors.lastname: Kateete
authors.forename: Anne
authors.initials: A
authors.lastname: Wajja
authors.forename: Eric
authors.initials: E
authors.lastname: Bugumirwa
authors.forename: Gerald
authors.initials: G
authors.lastname: Mboowa
authors.forename: Carolyn
authors.initials: C
authors.lastname: Namaganda
authors.forename: Germine
authors.initials: G
authors.lastname: Nakayita
authors.forename: Maria
authors.initials: M
authors.lastname: Nassolo
authors.forename: Francis
authors.initials: F
authors.lastname: Mumbowa
authors.forename: Benon B
authors.initials: BB
authors.lastname: Asiimwe
authors.forename: James
authors.initials: J
authors.lastname: Waako
authors.forename: Suzanne
authors.initials: S
authors.lastname: Verver
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Moses L
authors.initials: ML
authors.lastname: Joloba