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...

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Main Authors:	How, Soon Hin, Kuan, Yeh Chunn, Ng, Teckhan, Razali, M. R A
Format:	Article
Language:	English English English
Published:	Malaysian Society of Pathologists 2014
Subjects:	R Medicine (General) RC Internal medicine
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

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spelling	iium-584742017-09-21T09:33:27Z http://irep.iium.edu.my/58474/ Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph How, Soon Hin Kuan, Yeh Chunn Ng, Teckhan Razali, M. R A R Medicine (General) RC Internal medicine 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 Malaysian Society of Pathologists 2014 Article PeerReviewed application/pdf en http://irep.iium.edu.my/58474/1/58474_Monitoring%20treatment%20response%20_article.pdf application/pdf en http://irep.iium.edu.my/58474/2/58474_Monitoring%20treatment%20response%20_wos.pdf application/pdf en http://irep.iium.edu.my/58474/3/58474_Monitoring%20treatment%20response%20_scopus.pdf How, Soon Hin and Kuan, Yeh Chunn and Ng, Teckhan and Razali, M. R A (2014) Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph. Malaysian Journal of Pathology, 36 (2). pp. 91-96. ISSN 0126-8635 http://www.mjpath.org.my/2014/v36n2/pulmonary-tuberculosis.pdf
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English English
topic	R Medicine (General) RC Internal medicine
spellingShingle	R Medicine (General) RC Internal medicine How, Soon Hin Kuan, Yeh Chunn Ng, Teckhan Razali, M. R A Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
description	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
format	Article
author	How, Soon Hin Kuan, Yeh Chunn Ng, Teckhan Razali, M. R A
author_facet	How, Soon Hin Kuan, Yeh Chunn Ng, Teckhan Razali, M. R A
author_sort	How, Soon Hin
title	Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
title_short	Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
title_full	Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
title_fullStr	Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
title_full_unstemmed	Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph
title_sort	monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: comparison of weight gain, sputum conversion and chest radiograph
publisher	Malaysian Society of Pathologists
publishDate	2014
url	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
first_indexed	2023-09-18T21:22:41Z
last_indexed	2023-09-18T21:22:41Z
_version_	1777411987048759296

Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: Comparison of weight gain, sputum conversion and chest radiograph

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