Aylin Babalık, Şule Kızıltaş, Hülya Arda

Factors affecting smear conversion in tuberculosis management

ABSTRACT Setting: Inpatient clinic at Ministry of Health Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital Objective: To identify risk factors associated with persistent sputum positivity at the end of 2 months of direct observed treatment Design: Retrospective cohort study concerning evaluation of medical records of 547 patients with smear positive tuberculosis treated at our clinic from January 2004 to December 2005 Results: Of 547 patients with AFB positive smears, late conversion occurred in 11.9% while early conversion in 88.1%. Males composed 54.7% of the population, 31.9% of the population was â¤25 years old, 37.5% had exposure to tobacco, 15.7% had any drug resistance, 8.9% had co-morbid diabetes mellitus and 16.0% had extensive radiologic involvement. Based on significant association between sputum smear conversion and smoking for more than 20 package/year (<0.001), being over 40 years old (<0.001), being male (<0.001) and having extended radiological involvement (0.007), the logistic regression analysis revealed smoking >20 package/year (OR=4.11; 95% CI=2.13-7.94) and extended radiological findings (OR=2.3; 95% CI=1.21-4.37) to be statistically significant predictors of sputum smear conversion. Conclusion: Our findings confirm the relationship between TB and tobacco and indicate smoking>20 package/year and extended radiological findings as significant independent predictors of sputum smear conversion.

Anahtar Kelimeler:

-

Factors affecting smear conversion in tuberculosis management

Keywords:

Tuberculosis, smoking, risk factor sputum smear,

PDF

___

Global Tuberculosis Control. WHO Report 2010. WHO/HTM/TB/2010.7
Santha T. What is the optimum duration of treatment? In: TOMAN’S tuberculosis cases detection, treatment, and monitoring. WHO Geneva, second edition 2004, p 144.
COMPEDIUM of indicators for monitoring and evaluating national tuberculosis programs WHO/HTM/TBT 2004.344
Treatment of tuberculosis guidelines. Fourth Edition. World Health Organization. WHO/HTM/TB/2009.420
Pai M, Mohan A, Dheda K, Leung CC, Yew WW, Christopher DJ, Sharma SK. Lethal interaction: the colliding epidemics of tobacco and tuberculosis. Expert Rev Anti Infect Ther. 2007;5(3):385-91.
Slama K, Chiang CY, Enarson DA, Hassmiller K, Fanning A, Gupta P, Ray C. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. Int J Tuberc Lung Dis. 2007;11(10):1049-61.
Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med. 2007;4(1):e20.
Bates MN, Khalakdina A, Pai M, Chang L, Lessa F, Smith KR. Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Intern Med. 2007;167(4):335-42.
Santha T. How can the progress of treatment be monitored? In: TOMAN’S tuberculosis cases detection, treatment, and monitoring WHO Geneva, 2nd ed. 2004;250-5.
Santha T. How important is follow-up and what is the frequency of relapse after the completion of treatment? TOMAN’S tuberculosis cases detection, treatment, and monitoring. WHO Geneva, 2nd ed. 2004;267-9.
Horne DJ, Royce SE, Gooze L, Narita M, Hopewell PC, Nahid P, Steingart KR. Sputum monitoring during tuberculosis treatment for predicting outcome: systematic review and meta-analysis. Lancet Infect Dis. 2010;10(6):387-94.
Treatment of Tuberculosis: Guidelines for national programmes. World Health Organization-Geneva, 3 ed. 2003. rd
Guler M, Unsal E, Dursun B, Aydin O, Capan N. Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis. Int J Clin Pract. 2007;61(2):231-5.
Telzak EE, Fazal BA, Pollard CL, Turett GS, Justman JE, Blum S. Factors influencing time to sputum conversion among patients with smear-positive pulmonary tuberculosis. Clin Infect Dis. 1997;25(3):666-70.
Domínguez-Castellano A, Muniain MA, Rodriguez-Baño J, Garcia M, Rios MJ, Galvez J, Perez-Cano R. Factors associated with time to sputum smear conversion in active pulmonary tuberculosis. Int J Tuberc Lung Dis. 2003;7(5):432-8.
Singla R, Osman MM, Khan N, Al-Sharif N, Al-Sayegh MO, Shaikh MA. Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment. Int J Tuberc Lung Dis. 2003;7(1):58-64.
Banu Rekha VV, Balasubramanian R, Swaminathan S, Ramachandran R, Rahman F, Sundaram V, Thyagarajan K, Selvakumar N, Adhilakshmi AR, Iliayas S, Narayanan PR. Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: An analysis of risk factors. Indian J Med Res. 2007;126(5):452-8.
Arora VK, Singla N, Sarin R. Profile of geriatric patients under DOTS in Revised National Tuberculosis Control Programme. Indian J Chest Dis Allied Sci. 2003;45(4):231-5.
Hiyama J, Marukawa M, Shiota Y, Ono T, Mashiba H. Factors influencing response to treatment of pulmonary tuberculosis. Acta Med Okayama. 2000;54(4):139-45.
Leung CC, Yew WW, Chan CK, Tam CM, Lam CW, Chang KC, Chau CH, Lau KS, Law WS. Smoking and tuberculosis in Hong Kong. Int J Tuberc Lung Dis. 2003;7(10):980-6.
Abal AT, Jayakrishnan B, Parwer S, El Shamy A, Abahussain E, Sharma PN. Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis. Respir Med. 2005;99(4):415-20.
Durban Immunotherapy Trial Group. Immunotherapy with Mycobacterium vaccae in patients with newly diagnosed pulmonary tuberculosis: a randomised controlled trial. Lancet. 1999;354(9173):116-9.
Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg 2009;80(4):634-9.
Fitzwater SP, Caviedes L, Gilman RH, Coronel J, LaChira D, Salazar C, Saravia JC, Reddy K, Friedland JS, Moore DA. Prolonged infectiousness of tuberculosis patients in a directly observed therapy short-course program with standardized therapy. Clin Infect Dis. 2010;51(4):371-8.