Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
Background: Monitoring treatment response to anti-tuberculous therapy remains unsatisfactory in resource-limited countries where sophisticated and expensive tests are not readily available. Sputum culture for mycobacterium is desirable, but not obtainable in many developing countries. Sputum acid...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English English English |
| Published: |
Malaysian Society of Pathologists
2014
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/58474/ http://irep.iium.edu.my/58474/ http://irep.iium.edu.my/58474/1/58474_Monitoring%20treatment%20response%20_article.pdf http://irep.iium.edu.my/58474/2/58474_Monitoring%20treatment%20response%20_wos.pdf http://irep.iium.edu.my/58474/3/58474_Monitoring%20treatment%20response%20_scopus.pdf |
| Summary: | Background: Monitoring treatment response to anti-tuberculous therapy remains unsatisfactory in
resource-limited countries where sophisticated and expensive tests are not readily available. Sputum
culture for mycobacterium is desirable, but not obtainable in many developing countries. Sputum
acid-fast bacilli (AFB) smear alone can be misinterpreted in the presence of unviable bacilli or
non-tuberculous mycobacteria. Hence the search for a cheaper but reliable monitoring tool, or a
combination of several tools, continues. Interesting reports from studies in third world nations have
considered weight gain/loss as one such monitoring tool. Since pulmonary tuberculosis is endemic
in this country, we take the opportunity to evaluate weight gain and chest radiograph, compared to
sputum AFB smear in monitoring patient’s response. Methods: This was a retrospective study of
confirmed positive sputum AFB smear patients from January 1999 to December 2004 who attended
the Chest Clinic at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia. Data on weight, chest
radiograph and sputum AFB smear from initiation of therapy to end of treatment and follow-up
were collected and analyzed. Results: 201 patients were included. At week-4 of anti-tuberculous
treatment, only 14.7% had positive sputum smear. At completion of therapy 93.1% had improved
chest radiographs. 90% had weight gain, 5% had weight loss and the remaining had no change in
weight. Amongst patients with weight loss, there were no significant differences in the underlying
illnesses (p=0.376), sputum smear at 4 weeks (p=0.697) and chest X-ray changes (p=0.731). Three
patients who initially showed sputum smear conversion had reappearance of positive smear results
towards the end of treatment. One of them was diagnosed as treatment failure while the other two
remained well after discontinuation of therapy. Conclusion: Weight gain is very common among
smear-positive tuberculosis patients after treatment even though weight gain does not correlate
well with underlying disease, sputum conversion and chest X-ray changes. Reappearance of
smear-positive sputum must be interpreted with caution and not to be regarded as treatment failure
without other evidence |
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