Turan KARAGÖZ, Ebru DAMADOĞLU, Bayram Ümmühan SELVİ, Mualla PARTAL, Esen AKKAYA, Sinem GÜNGÖR, Adnan YILMAZ

Diagnostic value of repeated sputum examinations in pulmonary tuberculosis:How many sputum specimens are adequate?

Bu çalışmanın amacı akciğer tüberkülozunun tanısında çok sayıda balgam örneklerinin incelenmesinin değerini araştırmaktı. 2002 yılı süresince kültür pozitif akciğer tüberkülozu tanılı hastaların balgam yayma ve kültür sonuçlarını analiz ettik. 1027 hastada tanı balgam örneklerinde tüberküloz basilinin saptanması ile elde edilmişti. Laboratuvara gönderilen balgam sayısı 634 olguda bir, 167 olguda iki, 186 olguda üç ve 48 olguda üçten fazla idi. 760 (% 74) olgu pozitif yayma sonucuna sahipti. Yayma pozitif olguların % 82.3’ünde birinci balgamın yayma incelemesi pozitif idi. Bu grup olguların % 94.9’unda birinci veya ikinci balgam örneğinin yayma incelemesi pozitif bulundu. Üçüncü balgamın yayma incelemesi % 4.2 ek tanı değerine sahipti. 863 (% 84) olguda birinci balgamın kültürü pozitifti. İkinci ve üçüncü balgamların kültür incelemeleri sırasıyla % 11 ve % 4.5 ek tanı değeri sağladı. Kültür pozitif olguların % 95’ine ilk iki balgam örneğinin kültür incelemesi ile tanı konuldu. Sonuç olarak akciğer tüberkülozlu olguların büyük çoğunluğuna iki balgam örneği incelemesi ile tanı konulabilir. Üç veya daha fazla balgam incelemesi yapılması küçük bir ek tanı değerine sahiptir.

Akciğer tüberkülozunda tekrarlanan balgam incelemelerinin tanısal değeri: Kaç tane balgam örneği yeterlidir?

The aim of this study was to assess the value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis (PTB). We analyzed sputum smear and culture results of patients diagnosed with culture-proven PTB during 2002. In 1027 patients, the diagnosis was established by detection of M. Tuberculosis bacilli in sputum samples. The number of sputum specimens submitted to laboratory was one in 634 cases, two in 167 cases, three in 186 cases and more than three in 48 cases. 760 cases (74 %) had positive smear examination result. The first sputum smear examination was positive in 82.3 % of smear positive cases. Either the first or the second sputum was diagnostic in 94.9 % of these cases. Smear examination of third sputum revealed 4.2 % additional diagnostic yield. In 863 cases (84 %), culture examination of the first sputum was positive. The second and the third sputum culture examinations revealed additional diagnostic yield of 11 % and 4.5 %, respectively. Percent 95 of culture-proven cases were diagnosed with the first two sputum cultures. In conclusion the majority of PTB cases can be diagnosed with the examination of two sputum specimens. Three or more sputum specimens submitted obtain a small additional diagnostic yield.

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