HHS Public Access Author manuscript Author Manuscript
Eur Respir J. Author manuscript; available in PMC 2017 January 01. Published in final edited form as: Eur Respir J. 2016 January ; 47(1): 330–333. doi:10.1183/13993003.00877-2015.
Tuberculosis Screening using Ability to Provide Sputum in an Endemic Emergency Department Eduardo Ticona, MD, MScBT1,2, Moises A. Huaman, MD, MSc3, Luz Maria Huaroto, MD, MSc1,2, Marcos Burgos, MD4, Meghan Brett, MD4, Rod Escombe, MRCP, MRCGP, DTMandH, MSc, PhD5, and David AJ Moore, MD, DTM&H, MSc, FRCP5 1Infectious
Author Manuscript
Diseases and Tropical Medicine Service, Department of Medical Specialties, Hospital Nacional Dos de Mayo, Lima, Peru 2Department 3Division
of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY,
USA 4Division
of Infectious Diseases, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
5TB
Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
Author Manuscript
To the Editor Tuberculosis causes an enormous burden of morbidity and mortality worldwide [1]. Increasing rates of multi-drug (MDR) and extensively drug (XDR) resistant tuberculosis pose a serious threat to ongoing efforts in controlling the epidemic, particularly in low and middle-income countries [2].
Author Manuscript
The World Health Organization (WHO) recommends tuberculosis screening via sputum smear examination in adults attending outpatient health facilities who report cough for ≥2 weeks [3]. Little is known about optimal case finding definitions in emergency departments (ED) where the prevalence of tuberculosis appears to be higher than outpatient clinics [4]. Furthermore, EDs are highly important congregate settings bringing together the sickest diagnosed and undiagnosed tuberculosis patients with a vulnerable population, and may be the main portal of entry to care for persons who otherwise would not seek routine medical attention in outpatient clinics. We assessed the use of a simple case finding strategy based on obtaining a sputum sample for acid-fast smear and culture in all ED comers who could produce a sputum sample, regardless of reason for ED visit, report of cough symptoms, or cough duration.
Corresponding author: Moises A. Huaman, MD, MSc, Assistant Professor of Medicine, Division of Infectious Diseases, University of Kentucky, 740 South Limestone, K512, Lexington, KY 40536, Phone: 859-323-8178, Fax: 859-323-8926, [email protected]. Take home message: Screening all comers able to provide a sputum sample increased tuberculosis detection in an emergency department in Peru Potential conflicts of interest: All authors: No reported conflicts.
Ticona et al.
Page 2
Author Manuscript
The study was conducted between July 2005 and August 2006 in Hospital Nacional Dos de Mayo, a large public hospital in Lima, Peru serving a low-income area with a tuberculosis rate of 113 cases/100,000 inhabitants [5]. Patients evaluated in the ED were invited to participate in the study if they met the following criteria: ≥18 years of age, ≥2 hours stay in the ED, and ability to provide an adequate sputum sample for acid-fast bacilli (AFB) smear and culture. Patients who were receiving tuberculosis treatment at enrollment were excluded. Patients were enrolled from 8am through 8pm on Monday through Saturday. Participants provided written informed consent and were administered a standardized questionnaire to collect sociodemographic and clinical data including age, gender, residence location, occupation, medical history, tuberculosis risk factors and symptoms. One sputum sample was collected per patient.
Author Manuscript
Ziehl Neelsen AFB smear microscopy was performed on all sputum samples at the hospital laboratory. Sputum samples were cultured on acid buffered Ogawa media for eight weeks [6]. Susceptibility testing was performed at the Lima-Ciudad Regional Laboratory using the Proportional Method of Canetti and Grosset [7]. Pulmonary tuberculosis (PTB) was defined as having a sputum culture positive for Mycobacterium tuberculosis. MDR tuberculosis was defined as cultures resistant to at least isoniazid and rifampin. PTB patients were offered counselling for HIV testing. Stata software (version 12.0; StataCorp, Texas) was used for analysis. P values ≤0.05 were considered significant. The study was approved by the hospital Ethics Committee.
Author Manuscript
Over the study period, 931 patients were enrolled. Of these, 174 (18.7%) had PTB. The Table shows the characteristics of PTB patients by cough report. Forty-two (24.1%) of the 174 PTB patients reported no cough. Twenty-six (14.9%) PTB patients had cough for
Eur Respir J. Author manuscript; available in PMC 2017 January 01. Published in final edited form as: Eur Respir J. 2016 January ; 47(1): 330–333. doi:10.1183/13993003.00877-2015.
Tuberculosis Screening using Ability to Provide Sputum in an Endemic Emergency Department Eduardo Ticona, MD, MScBT1,2, Moises A. Huaman, MD, MSc3, Luz Maria Huaroto, MD, MSc1,2, Marcos Burgos, MD4, Meghan Brett, MD4, Rod Escombe, MRCP, MRCGP, DTMandH, MSc, PhD5, and David AJ Moore, MD, DTM&H, MSc, FRCP5 1Infectious
Author Manuscript
Diseases and Tropical Medicine Service, Department of Medical Specialties, Hospital Nacional Dos de Mayo, Lima, Peru 2Department 3Division
of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY,
USA 4Division
of Infectious Diseases, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
5TB
Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
Author Manuscript
To the Editor Tuberculosis causes an enormous burden of morbidity and mortality worldwide [1]. Increasing rates of multi-drug (MDR) and extensively drug (XDR) resistant tuberculosis pose a serious threat to ongoing efforts in controlling the epidemic, particularly in low and middle-income countries [2].
Author Manuscript
The World Health Organization (WHO) recommends tuberculosis screening via sputum smear examination in adults attending outpatient health facilities who report cough for ≥2 weeks [3]. Little is known about optimal case finding definitions in emergency departments (ED) where the prevalence of tuberculosis appears to be higher than outpatient clinics [4]. Furthermore, EDs are highly important congregate settings bringing together the sickest diagnosed and undiagnosed tuberculosis patients with a vulnerable population, and may be the main portal of entry to care for persons who otherwise would not seek routine medical attention in outpatient clinics. We assessed the use of a simple case finding strategy based on obtaining a sputum sample for acid-fast smear and culture in all ED comers who could produce a sputum sample, regardless of reason for ED visit, report of cough symptoms, or cough duration.
Corresponding author: Moises A. Huaman, MD, MSc, Assistant Professor of Medicine, Division of Infectious Diseases, University of Kentucky, 740 South Limestone, K512, Lexington, KY 40536, Phone: 859-323-8178, Fax: 859-323-8926, [email protected]. Take home message: Screening all comers able to provide a sputum sample increased tuberculosis detection in an emergency department in Peru Potential conflicts of interest: All authors: No reported conflicts.
Ticona et al.
Page 2
Author Manuscript
The study was conducted between July 2005 and August 2006 in Hospital Nacional Dos de Mayo, a large public hospital in Lima, Peru serving a low-income area with a tuberculosis rate of 113 cases/100,000 inhabitants [5]. Patients evaluated in the ED were invited to participate in the study if they met the following criteria: ≥18 years of age, ≥2 hours stay in the ED, and ability to provide an adequate sputum sample for acid-fast bacilli (AFB) smear and culture. Patients who were receiving tuberculosis treatment at enrollment were excluded. Patients were enrolled from 8am through 8pm on Monday through Saturday. Participants provided written informed consent and were administered a standardized questionnaire to collect sociodemographic and clinical data including age, gender, residence location, occupation, medical history, tuberculosis risk factors and symptoms. One sputum sample was collected per patient.
Author Manuscript
Ziehl Neelsen AFB smear microscopy was performed on all sputum samples at the hospital laboratory. Sputum samples were cultured on acid buffered Ogawa media for eight weeks [6]. Susceptibility testing was performed at the Lima-Ciudad Regional Laboratory using the Proportional Method of Canetti and Grosset [7]. Pulmonary tuberculosis (PTB) was defined as having a sputum culture positive for Mycobacterium tuberculosis. MDR tuberculosis was defined as cultures resistant to at least isoniazid and rifampin. PTB patients were offered counselling for HIV testing. Stata software (version 12.0; StataCorp, Texas) was used for analysis. P values ≤0.05 were considered significant. The study was approved by the hospital Ethics Committee.
Author Manuscript
Over the study period, 931 patients were enrolled. Of these, 174 (18.7%) had PTB. The Table shows the characteristics of PTB patients by cough report. Forty-two (24.1%) of the 174 PTB patients reported no cough. Twenty-six (14.9%) PTB patients had cough for
