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Research explores alternative smear collection methods for TB
Cuevas LE. PLoS Med. 2011;doi:10.1371/journal.pmed.1000443.
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New data are suggesting faster and less comprehensive forms of sputum collection may be available to help clinicians diagnose tuberculosis.
Luis E. Cuevas, MD, and colleagues at the Liverpool School of Tropical Medicine, and Andrew Ramsay at WHO-TDR Special Programme for Research and Training in Tropical Diseases analyzed data of 6,627 patients in Ethiopia, Nepal, Nigeria and Yemen who had demonstrated a cough for more than 2 weeks.
In the main analysis, the centers participating in the study were randomly assigned each week for a year to use different methods of sputum collection.
The researchers said a sputum collection scheme in which two samples are collected 1 hour apart followed by a morning specimen could identify as many smear-positive patients as the standard “spot-morning-spot” scheme, in which patients provide an on-the-spot specimen during their initial consultation, a specimen collected at home the next morning, and another on-the-spot specimen when they bring their morning specimen to the clinic. The study also confirmed that examination of the first two specimens alone identifies most smear-positive patients, independently of which scheme is used.
“A single-visit diagnosis would represent a substantial opportunity to improve the delivery of TB services, particularly to the poor,” the researchers concluded.
In the second analysis, which is a sub-study of the main trial, the researchers examined nearly 2,400 patients to show that a faster laboratory test, which is a variant form of smear microscopy — light emitting-diode fluorescence microscopy (LED-FM), could identify more people with TB than the standard smear microscopy test. However, in that analysis, the researchers said the false-positive rate was higher among the LED-FM tests.
Disclosures: The research was funded by the Bill & Melinda Gates Foundation and the United States Agency for International Development through grants awarded to the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. One of the researchers reported being employed by WHO, which administered the USAID and BMGF grants that funded the study.
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