Improving the diagnosis of tuberculosis through optimization of sputum microscopy

Background: Patient compliance is an important component of the case detection. The feasibility of sputum examination on the same day was assessed without compromising on the quality. Materials and Methods: This study was conducted as a cross-sectional study on 215 patients attending the DOTS center in Dr. Rajendra Prasad Government Medical College, Kangra, at Tanda from July 2018 to December 2018. The patients were divided into three arms of the study based on the timing of the sputum sample. Results: There was a high correlation of the test result across all study groups. Combined for all arms, the correlation between the first spot and second spot sputum sample was 0.87, between the first spot and morning sputum sample was 0.82, and between the second spot and morning sputum sample was 0.85. There was no significant statistical difference in the sputum positivity among the groups. The loss to follow-up (LFU) was high (21.9%) for the second and third spot (early morning) samples in group 2, and no LFU was observed for the second spot (after 1 h) and morning sample in group 1 patients. Conclusion: The combination of the first and early morning samples offers a feasible mechanism to diagnose tuberculosis (TB) based on acid fast bacillus identification. Establishing the diagnosis for TB based on two sample results is feasible without any significant drop in the yield.