TAILIEUCHUNG - REVISION OF THE CASE DEFINITION FOR SPUTUM SMEAR POSITIVE PULMONARY TB BACKGROUND DOCUMENT

The indications for these surgical procedures were: recurrent hemoptysis (24 cases), massive hemoptysis (4 cases), multi drug resistant TB (4 cases), bronchiectasis and recurrent infection (2 cases), and right bronchial stenosis (1 case). In two of the patients the indication for surgery was intra-bronchial carcinoid tumour. Lymph node biopsies obtained during the surgery showed pathological changes of TB. The most important complications observed were severe bleeding occurring after right pneumonectomy, empyema at the site of left superior lobectomy, and stenosis at the distal part of trachea in a patient who had right bronchial stenosis and destruction of superior lobe for which sleeve lobectomy was performed | World Health Organization 20 AVENUE Appia - CH-1211 Geneva 27 - Switzerland - Tel central 41 22 791 2111 - Fax central 41 22 791 3111 Revision of the case definition for sputum smear positive pulmonary TB Background document Current international policy for case detection The World Health Organization WHO in its first Framework for Effective Tuberculosis Control 1 defined sputum smear-positive tuberculosis as follows 1. Tuberculosis in a patient with at least two initial sputum smear examinations direct smear microscopy positive for acid fast bacilli AFB or 2. Tuberculosis in a patient with one sputum examination positive for AFB and radiographic abnormalities consistent with active pulmonary tuberculosis as determined by the treating medical officer or 3. Tuberculosis in a patient with one sputum specimen positive for AFB and culture positive for AFB . In a subsequent joint publication WHO the International Union against Tuberculosis and Lung Disease The Union and the Royal Netherlands Tuberculosis Association KNCV confirmed the definition 2. Proposed new definition With the prerequisite of a functional external quality assurance EQA system with blind rechecking the proposed definition is a patient with one or more initial sputum smear examinations positive for acid fast bacilli AFB . It should be noted that the definition of bacteriological failures has not been reviewed hence no change in the definition of failure cases is proposed at this stage. Rationale for laboratory diagnosis of tuberculosis by sputum microscopy based on a single positive smear 1. Sensitivity and specificity of acid-fast microscopy More than 30 years ago international studies performed in India and Singapore demonstrated that the first two examinations can detect as much as 95 of sputum and culture positive cases. Indian studies illustrated that the first specimen was positive in about 85 of culture positive cases while the second specimen was positive in an additional 10 of .

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