Keywords
DOTS, Mycobacterium Sputum Smear, Treatment failure, tuberculosis, Smear grading
Abstract
Introduction: Tuberculosis (TB) is one of the most challenging diseases in diagnosis, treatment and control. We aimed to assess the association of the initial grading of Mycobacterium Sputum Smear (MSS) on the outcomes of TB treatment.
Materials and Methods: In a historical study, data of 418 positive pulmonary smear patients were retrieved from the TB registration system in Iran during 2014 to 2020. Patients’ data included demographic, laboratory and clinical information and were recorded in our checklist. The grading of Mycobacterium Sputum Smear (MSS) at the initial treatment was assessed based on WHO guidelines. Chi-square test was used to assess the relationship between tuberculosis treatment outcomes and mycobacterium grade at initial treatment in SPSS.
Results: The mean age of cases was 51.19±22.29 years old and varied between 14 and 95 years. Laboratory results showed that the rate of 1-9, 1+,2+ and 3+ mycobacterium tuberculosis was 17.7%, 44.3%, 19.4% and 18.7%, respectively. The rate of cure, death and treatment failure in our patients was 87.1%, 6.9%, and 1.2%, respectively. The highest mortality rate (11.5%) occurred in patients with 3+ and the lower rate of cure was 79.5% in this group. Moreover, by increasing the mycobacterium grade the rate of transferred out and lost to follow up from treatment increased (p=0.024).
Conclusion: Death, treatment failure, lost to follow up and transferred out is more common in patients who have higher MSS. Therefore, improvement the health system and patient-diagnosis and screening programs is necessary to on-time diagnosis and facilitate the treatment process.
References
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25. Bouti K, Aharmim M, Marc K, Soualhi M, Zahraoui R, Benamor J, et al. Factors Influencing Sputum Conversion among Smear-Positive Pulmonary Tuberculosis Patients in Morocco. ISRN Pulmonology. 2013;2013:486507. doi: 10.1155/2013/486507.
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27. Atif M, Sulaiman SA, Shafie AA, Ali I, Asif M, Babar ZU. Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia. BMC infectious diseases. 2014;14:399. Epub 2014/07/20. doi: 10.1186/1471-2334-14-399. PubMed PMID: 25037452; PubMed Central PMCID: PMCPMC4223646.
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29. Rajpal S, Dhingra V, Aggarwal J. Sputum grading as predictor of treatment outcome in pulmonary tuberculosis. Indian Journal of Tuberculosis. 2002;49(3):139-42.
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31. Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, et al. Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study. PloS one. 2020;15(4):e0231986. Epub 2020/04/23. doi: 10.1371/journal.pone.0231986. PubMed PMID: 32320443; PubMed Central PMCID: PMCPMC7176104.
32. Shahrezaei M, Maracy MR, Farid F. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011. Int J Prev Med. 2015;6:91-. doi: 10.4103/2008-7802.165157. PubMed PMID: 26445638.
33. Sengul A, Akturk UA, Aydemir Y, Kaya N, Kocak ND, Tasolar FT. Factors affecting successful treatment outcomes in pulmonary tuberculosis: a single-center experience in Turkey, 2005-2011. Journal of infection in developing countries. 2015;9(8):821-8. Epub 2015/09/01. doi: 10.3855/jidc.5925. PubMed PMID: 26322873.
34. Gebrezgabiher G, Romha G, Ejeta E, Asebe G, Zemene E, Ameni G. Treatment Outcome of Tuberculosis Patients under Directly Observed Treatment Short Course and Factors Affecting Outcome in Southern Ethiopia: A Five-Year Retrospective Study. PloS one. 2016;11(2):e0150560-e. doi: 10.1371/journal.pone.0150560. PubMed PMID: 26918458.
35. Patel SV, Nimavat KB, Alpesh PB, Shukla LK, Shringarpure KS, Mehta KG, et al. Treatment outcome among cases of multidrug-resistant tuberculosis (MDR TB) in Western India: A prospective study. Journal of Infection and Public Health. 2016;9(4):478-84. doi: https://doi.org/10.1016/j.jiph.2015.11.011.
2. Sunday O, Oladimeji O, Ebenezer F, Akintunde B, Abiola T-O, Saliu A, et al. Treatment Outcome of Tuberculosis Patients Registered at DOTS Centre in Ogbomoso, Southwestern Nigeria: A 4-Year Retrospective Study. Tuberculosis Research and Treatment. 2014;2014:201705. doi: 10.1155/2014/201705.
3. Caetano Mota P, Carvalho A, Valente I, Braga R, Duarte R. Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis. Revista portuguesa de pneumologia. 2012;18(2):72-9. Epub 2012/01/27. doi: 10.1016/j.rppneu.2011.12.005. PubMed PMID: 22277838.
4. Adebisi YA, Agumage I, Sylvanus TD, Nawaila IJ, Ekwere WA, Nasiru M, et al. Burden of Tuberculosis and Challenges Facing Its Eradication in West Africa. Int J Infect. 2019;6(3):e92250. Epub 2019-09-02. doi: 10.5812/iji.92250.
5. Metanat M, Sharifi-Mood B, Alavi-Naini R, Aminianfar M. The epidemiology of tuberculosis in recent years: Reviewing the status in south-eastern Iran. Zahedan Journal of Research in Medical Sciences. 2012;13(9).
6. Khazaei s, Zahiri a, Hasanbeigi a, Mohammadian-hafshejani a, Salehiniya h, Saatchi m, et al. Effect of Intensity of Sputum Smear Positive in Pulmonary Tuberculosis Patients at the Beginning of Treatment on Treatment Outcome. J Ilam Univ Med Sci. 2016;24(1):1-7[In Persian]. doi: 10.18869/acadpub.sjimu.24.1.1.
7. Gunda DW, Nkandala I, Kavishe GA, Kilonzo SB, Kabangila R, Mpondo BC. Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study. J Trop Med. 2017;2017:5352906-. Epub 06/11. doi: 10.1155/2017/5352906. PubMed PMID: 28694828.
8. Diallo A, Dahourou DL, Dah TTE, Tassembedo S, Sawadogo R, Meda N. Factors associated with tuberculosis treatment failure in the Central East Health region of Burkina Faso. Pan Afr Med J. 2018;30:293. Epub 2019/01/15. doi: 10.11604/pamj.2018.30.293.15074. PubMed PMID: 30637077; PubMed Central PMCID: PMCPMC6320454.
9. Diktanas S, Vasiliauskiene E, Polubenko K, Danila E, Celedinaite I, Boreikaite E, et al. Factors Associated with Persistent Sputum Positivity at the End of the Second Month of Tuberculosis Treatment in Lithuania. Tuberculosis and respiratory diseases. 2018;81(3):233-40. Epub 2018/06/22. doi: 10.4046/trd.2017.0096. PubMed PMID: 29926543; PubMed Central PMCID: PMCPMC6030656.
10. Lohmann EM, Koster BF, le Cessie S, Kamst-van Agterveld MP, van Soolingen D, Arend SM. Grading of a positive sputum smear and the risk of Mycobacterium tuberculosis transmission. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2012;16(11):1477-84. Epub 2012/09/12. doi: 10.5588/ijtld.12.0129. PubMed PMID: 22964038.
11. Morris L, Hiasihri S, Chan G, Honjepari A, Tugo O, Taune M, et al. The emergency response to multidrug-resistant tuberculosis in Daru, Western Province, Papua New Guinea, 2014-2017. Public health action. 2019;9(Suppl 1):S4-S11. doi: 10.5588/pha.18.0074. PubMed PMID: 31580333.
12. Taghizade Moghaddam H, Emami Moghadam Z, Khademi G, Bahreini A, Saeidi M. Tuberculosis: Past, Present and Future. International Journal of Pediatrics. 2016;4(1):1243-54. doi: 10.22038/ijp.2016.6266.
13. Gupta SN, Gupta N, Gupta S. Surveillance data analysis of Revised National Tuberculosis Control Program of Kangra, Himachal Pradesh. J Family Med Prim Care. 2013;2(3):250-5. doi: 10.4103/2249-4863.120730. PubMed PMID: 24479092.
14. Sawadogo B, Tint KS, Tshimanga M, Kuonza L, Ouedraogo L. Risk factors for tuberculosis treatment failure among pulmonary tuberculosis patients in four health regions of Burkina Faso, 2009: case control study. Pan Afr Med J. 2015;21:152-. doi: 10.11604/pamj.2015.21.152.4827. PubMed PMID: 26327989.
15. Tiwari S, Kumar A, Kapoor SK. Relationship between sputum smear grading and smear conversion rate and treatment outcome in the patients of pulmonary tuberculosis undergoing dots--a prospective cohort study. The Indian journal of tuberculosis. 2012;59(3):135-40. Epub 2013/02/01. PubMed PMID: 23362709.
16. Quissell K, Walt G. The challenge of sustaining effectiveness over time: the case of the global network to stop tuberculosis. Health Policy Plan. 2016;31 Suppl 1(Suppl 1):i17-i32. Epub 08/17. doi: 10.1093/heapol/czv035. PubMed PMID: 26282859.
17. Glaziou P, Sismanidis C, Floyd K, Raviglione M. Global epidemiology of tuberculosis. Cold Spring Harb Perspect Med. 2014;5(2):a017798-a. doi: 10.1101/cshperspect.a017798. PubMed PMID: 25359550.
18. Fallah S, Salarilak Sh, Khalkhali HR, Nejadrahim R, Nasehi M. Effective factors of treatment outcome in smear positive tuberculosis patients in Golestan province-Iran (2014). Journal of Gorgan University of Medical Sciences. 2016;18(2):102-7.
19. Kayigamba FR, Bakker MI, Mugisha V, De Naeyer L, Gasana M, Cobelens F, et al. Adherence to tuberculosis treatment, sputum smear conversion and mortality: a retrospective cohort study in 48 Rwandan clinics. PloS one. 2013;8(9):e73501. Epub 2013/09/26. doi: 10.1371/journal.pone.0073501. PubMed PMID: 24066053; PubMed Central PMCID: PMCPMC3774710.
20. Yari M, Molaeipour L, Jafari MR, Valipour AA, Khazaei S, Roushanaei G. Assessing relation between sputum smear grading in positive pulmonary Tuberculosis patients with treatment outcome. Pajouhan Scientific Journal. 2016;14(4):1-7. doi: 10.21859/psj-140401.
21. World Health Organization. WHO guidelines on tuberculosis infection prevention and control: 2019 update: World Health Organization; 2019.
22. Nasehi M, Mirhaghani L. National guideline on Tuberculosis control. Andishmand publication, Tehran. 2001:[In Persian].
23. Moosazadeh M, Bahrampour A, Nasehi M, Khanjani N. The incidence of recurrence of tuberculosis and its related factors in smear-positive pulmonary tuberculosis patients in Iran: A retrospective cohort study. Lung India : official organ of Indian Chest Society. 2015;32(6):557-60. Epub 2015/12/15. doi: 10.4103/0970-2113.168113. PubMed PMID: 26664159; PubMed Central PMCID: PMCPMC4663856.
24. Melese A, Zeleke B. Factors associated with poor treatment outcome of tuberculosis in Debre Tabor, northwest Ethiopia. BMC Research Notes. 2018;11(1):25. doi: 10.1186/s13104-018-3129-8.
25. Bouti K, Aharmim M, Marc K, Soualhi M, Zahraoui R, Benamor J, et al. Factors Influencing Sputum Conversion among Smear-Positive Pulmonary Tuberculosis Patients in Morocco. ISRN Pulmonology. 2013;2013:486507. doi: 10.1155/2013/486507.
26. Liu Q, Lu P, Martinez L, Yang H, Lu W, Ding X, et al. Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China. BMC infectious diseases. 2018;18(1):114-. doi: 10.1186/s12879-018-3021-0. PubMed PMID: 29510666.
27. Atif M, Sulaiman SA, Shafie AA, Ali I, Asif M, Babar ZU. Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia. BMC infectious diseases. 2014;14:399. Epub 2014/07/20. doi: 10.1186/1471-2334-14-399. PubMed PMID: 25037452; PubMed Central PMCID: PMCPMC4223646.
28. Hoa NB, Sokun C, Wei C, Lauritsen JM, Rieder HL. Time to unsuccessful tuberculosis treatment outcome, Cambodia, China, and Viet Nam. Public health action. 2012;2(1):15-20. Epub 2012/03/21. doi: 10.5588/pha.11.0024. PubMed PMID: 26392939; PubMed Central PMCID: PMCPMC4536555.
29. Rajpal S, Dhingra V, Aggarwal J. Sputum grading as predictor of treatment outcome in pulmonary tuberculosis. Indian Journal of Tuberculosis. 2002;49(3):139-42.
30. Izudi J, Tamwesigire IK, Bajunirwe F. Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study. BMC public health. 2020;20(1):501. Epub 2020/04/17. doi: 10.1186/s12889-020-08646-0. PubMed PMID: 32295549; PubMed Central PMCID: PMCPMC7161267.
31. Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, et al. Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study. PloS one. 2020;15(4):e0231986. Epub 2020/04/23. doi: 10.1371/journal.pone.0231986. PubMed PMID: 32320443; PubMed Central PMCID: PMCPMC7176104.
32. Shahrezaei M, Maracy MR, Farid F. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011. Int J Prev Med. 2015;6:91-. doi: 10.4103/2008-7802.165157. PubMed PMID: 26445638.
33. Sengul A, Akturk UA, Aydemir Y, Kaya N, Kocak ND, Tasolar FT. Factors affecting successful treatment outcomes in pulmonary tuberculosis: a single-center experience in Turkey, 2005-2011. Journal of infection in developing countries. 2015;9(8):821-8. Epub 2015/09/01. doi: 10.3855/jidc.5925. PubMed PMID: 26322873.
34. Gebrezgabiher G, Romha G, Ejeta E, Asebe G, Zemene E, Ameni G. Treatment Outcome of Tuberculosis Patients under Directly Observed Treatment Short Course and Factors Affecting Outcome in Southern Ethiopia: A Five-Year Retrospective Study. PloS one. 2016;11(2):e0150560-e. doi: 10.1371/journal.pone.0150560. PubMed PMID: 26918458.
35. Patel SV, Nimavat KB, Alpesh PB, Shukla LK, Shringarpure KS, Mehta KG, et al. Treatment outcome among cases of multidrug-resistant tuberculosis (MDR TB) in Western India: A prospective study. Journal of Infection and Public Health. 2016;9(4):478-84. doi: https://doi.org/10.1016/j.jiph.2015.11.011.