The data at the end of the fifth month are also consistent with those of our previous study, which showed only 25.2% (28/113) culture positivity in patients who were smear-positive at the end of the fifth month [5]. Patients with SPCN had longer treatment duration (rifampicin: 284 ± 91 vs. 235 ± 69 days, P <0.001; isoniazid: 289 ± 90 vs. 234 ± 69 days, P < 0.001) than those without SPCN. Taken together, our data show that sputum culture conversion and relapse rates are not affected by the sputum SPCN, possibly because patients with SPCN received treatment for longer than those without sputum SPCN. Ziehl–Nielsen stained smears were examined and graded according to the American Thoracic Society guidelines [11]. Early-morning sputum samples were decontaminated with NaOH. We believe the differential error was not caused by such an inhibitory effect on culturability in this study because all cases had positive cultures for Mtb in sputum on enrollment and the inhibitory effect on culturability was the same for all sputum samples throughout the study period. Google Scholar. This longitudinal study showed that SPCN develops as early as 30 days after initiating treatment and is rarely found after 240 days of treatment (Figure 2). To clarify the time course of SPCN and the effect of TB severity on the development of SPCN, we correlated sputum smear and culture conversion curve with TB severity. Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan, Department of Internal Medicine, Taichung Veteran General Hospital Chiayi Branch, Chiayi, Taiwan, Chang-Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Tao-Yuan Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, Hua-Lien Hospital, Ministry of Health and Welfare, Hualien, Taiwan, Chest Hospital, Ministry of Health and Welfare, #864, Zhongshan Rd, Rende District, Tainan, 717, Taiwan, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, You can also search for this author in Finally, SPCN is especially important in countries with limited laboratory capacity. To further explore the effect of TB severity on the development of sputum SPCN, we subdivided patients with cavities on CXR into those with cavities larger or less than 4 cm in diameter and their AFS grading was classified as negative, 1+ and ≥2+. When their interpretations differed, the image was further reviewed by a third chest specialist who was also blinded to the results. To further investigate the clinical impact of sputum SPCN, we assessed treatment regimens, outcomes, and relapse rate during the 3-year follow-up after completing treatment (Table 3) and found that the 111 patients with sputum SPCN received treatment for longer than the 689 without sputum SPCN. In accordance with the tuberculosis treatment guidelines in Taiwan [13], all patients’ sputum smears and cultures had been checked in the second and fifth months after initiation of treatment; monthly sputum checks had also been performed until sputum conversion in all patients with positive smears. Hsu CBLH, Lee CY, Yang SL, Wang KF, Yang SY. To evaluate the efficacy of three sputum acid-fast bacillus (AFB) smears to rule out pulmonary tuberculosis, sputum AFB smear and culture results were analyzed at two university-affiliated teaching hospitals.

Cavitation formation, a well-known characteristic presentation of TB infection, is believed to result from caseous granulomatous inflammation. CAS  Cases of relapse were also identified by reviewing the databases of the CDC; and diagnoses of relapse were based on both chest-X ray films (CXR) and adequate sputum mycobacterial evidence. http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf, http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf, https://doi.org/10.1186/s12879-015-0795-1, Tuberculosis and other mycobacterial diseases.

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