PURPOSE: With widespread availability of DOTS, the factors predicting treatment outcome needs to be determined. The present study was undertaken to determine the status of sputum grading as predictor of treatment outcome in open case of pulmonary tuberculosis .
METHODS: 150 newly diagnosed pulmonary tuberculosis patients were selected .Three Sputum specimens over two consecutive days from each patient were examined. Grading of sputum-smears was done as per guidelines of RNTCP. These patients were given intensive-phase of intermittent supervised chemotherapy for a period of 2 months (if still sputum positive, the intensive-phase extended by 1 month) & continuation-phase for further 4 months.
RESULTS: Majority of the patients were sputum grade 3+ , between 20-39 years of age & males 83(55.33%). Cough was the major complaint in 142 (94.67%) followed by fever (93.33%), loss of appetite (84%) and loss of weight (80%). 12.67% had scanty positive sputum for AFB, 26.67% had AFB 1+, 15.33% had AFB 2+. Patients scanty positive for AFB had 100% sputum conversion at the end of 2 months and all were cured at the end of treatment; 1+ for AFB had 92.50% sputum conversion at end of 2 months, 97.50% cured at the end of treatment; 2+ for AFB had 78.26% sputum conversion at the end of 2 months and at the end of treatment 82.6% were cured. Among patients 3+ for AFB, 70.59% were sputum negative at the end of intensive phase. Out of 18 patients still sputum positive at end of 3rd month, 2 patients became sputum negative at the end of treatment. 76.47% were cured and 23.53% were declared as failure.
CONCLUSION: Our findings showed that, the conversion and cure rates were lower in patients with higher sputum smear grade(scanty positive / 3+, X2 26.72, p<0.001). Also such patients had comparatively unfavourable treatment outcomes in terms of failure.
CLINICAL IMPLICATIONS: The smear grading under DOTS needs to be reviewed further. It necessitates more attention towards patients with higher sputum smear grading.
DISCLOSURE: HARPREET KAUR, No Financial Disclosure Information; No Product/Research Disclosure Information