title: What a difference a day makes: same-day vs. 2-day sputum smear microscopy for diagnosing tuberculosis.
abstract: Setting:Nine district-level microscopy centres in Assam and Tripura, India.Objective:Same-day sputum microscopy is now recommended for tuberculosis (TB) diagnosis. We compared this method against the conventional 2-day approach in routine programmatic settings.Methods:During October-December 2012, all adult presumptive TB patients were requested to provide three sputum samples (one at the initial visit, the second 1 h after the first sample, and the third the next morning) for examination by Ziehl-Neelsen smear microscopy. Detection of acid-fast bacilli with any sample was diagnostic. The first and second spot sample comprised the same-day approach, and the first spot sample and next-day sample comprised the 2-day approach.Results:Of 2168 presumptive TB patients, 403 (18.6%) were smear-positive according to the same-day method compared to 427 (19.7%) by the 2-day method (McNemar's test,P< 0.001). Of the total 429 TB patients, 26 (6.1%) were missed by the same-day method and 2 (0.5%) by the 2-day method.Conclusion:Same-day specimen collection for microscopy missed more TB than 2-day collection. In India, missing cases by using same-day microscopy would translate into a considerable absolute number, hindering TB control efforts. We question the indiscriminate switch to same-day diagnosis in settings where patients reliably return for testing the next day.
authors.affiliation: World Health Organization Country Office for India, New Delhi, India.
authors.forename: D J
authors.initials: DJ
authors.lastname: Deka
authors.affiliation: Department of Health, Government of Assam, Guwahati, Assam, India.
authors.forename: B
authors.initials: B
authors.lastname: Choudhury
authors.affiliation: World Health Organization Country Office for India, New Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Talukdar
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: T Q
authors.initials: TQ
authors.lastname: Lo
authors.affiliation: Department of Health, Government of Tripura, Agartala, Tripura, India.
authors.forename: B
authors.initials: B
authors.lastname: Das
authors.affiliation: World Health Organization Country Office for India, New Delhi, India.
authors.forename: S A
authors.initials: SA
authors.lastname: Nair
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Moonan
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union, South-East Asia Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
keywords: AFB; India; diagnosis; spot-morning; sputum microscopy; tuberculosis, spot-spot