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Médecine et maladies infectieuses
Volume 50, n° 1
pages 36-42 (février 2020)
Doi : 10.1016/j.medmal.2019.03.010
Received : 6 Mars 2018 ;  accepted : 13 Mars 2019
Infectiologie

Prospective study comparing the conventional and same-day strategies to diagnose pulmonary tuberculosis
Étude prospective comparant le dépistage conventionnel et la stratégie de dépistage le même jour de la tuberculose pulmonaire
 

A. Lopes a, , F. Mougari b, D. Chopin a, M. Pogliaghi a, A.-L. Munier c, V. Delcey a, G. Simoneau a, L. Raskine b, J. Evans a, S. Mouly a, E. Cambau b, J.-F. Bergmann a, P. Sellier a
a Département de médecine interne, université Paris Diderot, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance publique–Hôpitaux de Paris (AP–HP), 2, rue Ambroise-Paré, 75010 Paris, France 
b Service de microbiologie, université Paris Diderot, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance publique–Hôpitaux de Paris (AP–HP), 2, rue Ambroise-Paré, 75010 Paris, France 
c Département de maladies infectieuses, université Paris Diderot, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance publique–Hôpitaux de Paris (AP–HP), 2, rue Ambroise-Paré, 75010 Paris, France 

Corresponding author.
Highlights

Our study is the first study performed in a low tuberculosis (TB) burden country to show good concordance between the same-day sputum smear strategy and the conventional sputum smear strategy regarding smears and cultures.
If further studies performed on a larger scale were to confirm our results, the same-day sputum smear strategy could be used worldwide to diagnose TB.
Potential benefits are expected for individual patients as earlier diagnosis leads to earlier treatment.
At the public health level, earlier diagnosis of contagious pulmonary TB could lead to the adoption of preventive measures against air-borne transmission.
Earlier discharge from hospital for patients with negative acid-fast bacilli smears could lead to budgetary savings, although the negative smears do not preclude positive culture results.

The full text of this article is available in PDF format.
Abstract
Objective

The WHO recommends same-day sputum smear microscopy for the diagnosis of smear-positive tuberculosis (TB) in countries with high TB burden for earlier diagnosis and treatment, a cornerstone to prevent air-borne transmission. We aimed to compare the conventional strategy (sputum collection on three consecutive days) and the same-day strategy (hour h, h+1, h+2) in France, a country with low TB burden.

Patients and methods

Over a six-month period, all adult individuals presenting with presumptive smear-positive TB were eligible for the study, registered in clinicaltrials.gov/ ID (NCT 02961569). Sputum specimens were collected three times the first day, then once on the second day and once on the third day. The concordance between the two strategies regarding smears and cultures were assessed.

Results

Of the 131 eligible individuals, 34 were given a TB treatment. Smears from hour h, h+1, h+2, day two and three were negative in 19 of these 34 patients. Positive smears were obtained in 15, 14, 15, 14, and 14 patients at hour h, h+1, h+2, on day two and three, respectively. Concordance regarding smear or culture was good, with Kappa 0.69 and 0.64, respectively.

Conclusion

The same-day strategy seems to be a good alternative to the conventional strategy.

The full text of this article is available in PDF format.
Résumé

Objectif L’OMS recommande la réalisation de plusieurs BK-crachats le même jour pour le diagnostic de tuberculose pulmonaire bacillifère dans les pays à forte endémie de tuberculose pour faire rapidement le diagnostic et pour mettre en route rapidement le traitement, afin de diminuer la transmission aérienne. L’objectif était de comparer la stratégie conventionnelle de dépistage (3 BK-crachats 3jours de suite) et la stratégie plusieurs BK-crachats le même jour (heure h, h+1, h+2) en France, pays à faible prévalence de tuberculose.

Méthode

Sur une période de 6 mois, tous les adultes consécutifs ayant une suspicion de tuberculose pulmonaire ont été inclus dans l’étude (enregistrée dans clinicaltrials.gov/ ID –– NCT 02961569). Les BK-crachats ont été prélevés 3 fois le même jour puis un BK-crachat le 2e jour et un BK-crachat le 3e jour pour chaque patient. La concordance des résultats à l’examen direct et à la culture a été recueillie pour chaque patient.

Résultats

Sur 131 individus éligibles, 34 patients ont été traités pour une tuberculose. Les BK-crachats à l’heure h, h+1, h+2, jour 1 et jour 2 étaient négatifs chez 19 patients sur les 34 patients traités. Des BK-crachats étaient positifs chez 15, 14, 15, 14 et 14 patients à heure h, h+1, h+2, jour 2 et jour 3, respectivement. La concordance des crachats à l’examen direct et en culture était bonne avec un Kappa à 0,64 et 0,69, respectivement.

Conclusion

La stratégie de dépistage le même jour est une bonne alternative à la stratégie de dépistage conventionnel.

The full text of this article is available in PDF format.

Keywords : Earlier diagnosis, Tuberculosis

Mots clés : Diagnostic précoce, Tuberculose




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