Laure Stella Ghoma Linguissi¹*, Genevieve Andoseh¹, Brigitte Tumamo Fotso¹, Janine Merveille Mboko Ndangui¹, Narcisse Arsène Balou¹, Anne Magalie Murielle Mboungou Nzoussi¹ and Albert Mabiala²

¹Institut National de Recherche en Sciences de la Santé (IRSSA), Brazzaville, Republic of Congo
²Service des Maladies Infectieuses, Hopital de Référence de Makélékélé, Brazzaville, Republic of Congo

*Corresponding Author: Laure Stella Ghoma Linguissi, Institut National de Recherche en Sciences de la Santé (IRSSA), Brazzaville, Republic of Congo.

Received: May 03, 2021 ; Published: July 09, 2021

Abstract

The quality of sputum specimen remains crucial in the accurate diagnosis of TB. Good quality sputum makes for a high diagnostic yield while poor quality sputum yields false negative results and delays diagnosis. We aimed to determine the effect of sputum quality on smear microscopy results in a referral hospital in the Republic of Congo. The Sputum specimens were collected from suspected pulmonary TB patients and macroscopically observed using set quality parameters and then processed using standard Ziehl-Neelsen (ZN) staining for Acid fast bacilli (AFB). A total of 117 TB suspected patients submitted 229 sputum samples that was processed. Out of the 229 samples, 24.02% were of good quality (mucopurulent), 1.31% of average quality (blood tinged) and 72.49% of poor quality (saliva). There were 61 samples (26.64%) that tested positive for AFB while 168 (73.36%) were negative. The positive samples were mainly mucopurulent 88.52% (54/61), while the negative samples were mainly salivary 97,62% (164/168). Thus, 37 (31,62%) patients were diagnosed AFB smear positive (AFB+) and 80 (68.38%) AFB smear negative (AFB-). Smear negative TB was associated with poor quality sputum (saliva). The results of this study show that the quality of the sputum influences significantly the performance of microscopy for the diagnosis of pulmonary tuberculosis and reveals the fact that inadequate sputum quality compromises the national efforts to control TB. In our study we had a good performance of the macroscopic assessment that identified smear-positive respiratory specimens associated with mucopurulent sputum and smear-negative respiratory specimens associated with saliva. It will be of major importance for health authorities to develop measures that encourage proper and good quality sputum collection for early and accurate pulmonary tuberculosis diagnosis thereby reducing disease transmission within the population.

Keywords: Sputum Quality; Acid-Fast Bacilli (AFB); Smear Microscopy; Republic of Congo

References

1. World Health Organization. “Global tuberculosis report 2019”. Geneva: World Health Organization; (2019).
2. Nagabhushan Vidya NV., et al. “Comparative analysis of tuberculosisbacteria in saliva and sputum using Ziehl-Neelsen, Papanicolaou and bleach modified Papanicolaou induced fluorescent microscopy”. World Journal of Current Medical and Pharmaceutical Research 8 (2020): 258‑266.
3. Banu S. “Comparison of Macroscopic and Microscopic Assessment of Specimens Collected for the Diagnosis of Tuberculosis”. Open Infectious Diseases Journal 1 (2012): 1‑4.
4. Lee YJ., et al. “Acceptability of Sputum Specimens for Diagnosing Pulmonary Tuberculosis”. Journal of Korean Medical Science 6 (2015): 733.
5. Ho J., et al. “The impact of sputum quality on tuberculosis diagnosis: a systematic review”. The International Journal of Tuberculosis and Lung Disease5 (2015): 537-544.
6. Aparna L M., et al. “Assessment of Sputum Quality and Its Importance in the Rapid Diagnosis of Pulmonary Tuberculosis”. Archives of Clinical Microbiology4 (2017).
7. Budayanti NS., et al. “The Quality of Sputum Specimens as a Predictor of Isolated Bacteria From Patients With Lower Respiratory Tract Infections at a Tertiary Referral Hospital, Denpasar, Bali-Indonesia”. Frontiers in Medicine6 (2019): 64.
8. Orina F., et al. “Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients”. Plos One12 (2019): e0227107.
9. Okemba Okombi FH., et al. “Extensively resistant tuberculosis: Four cases in the Republic of Congo”. Medecine et Sante Tropicales3 (2018): 289‑291.
10. Okemba-Okombi FH., et al. “Apport du GeneXpert dans le diagnostic de la tuberculose pulmonaire : étude préliminaire et perspectives en République du Congo”. Revue des Maladies Respiratoires 32 (2015): A211.
11. Yoon SH., et al. “Impact of sputum gross appearance and volume on smear positivity of pulmonary tuberculosis: a prospective cohort study”. BMC Infectious Disease1 (2012): 172.
12. Linguissi LS., et al. “Prevalence of national treatment algorithm defined smear positive pulmonary tuberculosis in HIV positive patients in Brazzaville, Republic of Congo”. BMC Research Notes1 (2014): 578.
13. Dheda K., et al. “Point-of-care diagnosis of tuberculosis: Past, present and future: POC TB diagnostics review”. Respirology2 (2013): 217‑232.
14. Sakundarno M., et al. “Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia”. BMC Pulmonary Medicine1 (2019): 16.
15. Mhalu G., et al. “Do Instructional Videos on Sputum Submission Result in Increased Tuberculosis Case Detection? A Randomized Controlled Trial”. Plos One9 (2015): e0138413.
16. Datta S., et al. “Comparison of sputum collection methods for tuberculosis diagnosis: a systematic review and pairwise and network meta-analysis”. Lancet Global Health8 (2017): e760‑771.
17. Khan MS., et al. “Judging respiratory specimen acceptability for AFB microscopy: visual vs. microscopic screening”. Tropical Medicine and International Health 5 (2009): 571‑575.
18. Meyer AJ., et al. “Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda”. Plos One7 (2017): e0180572.
19. Asemahagn MA., et al. “Determinants of Sputum Smear Positivity among Tuberculosis Suspected Patients in Bahir Dar City, Northwest Ethiopia”. Nursing and Health Sciences (2018).
20. Campos LC., et al. “Characteristics of Patients with Smear-Negative Pulmonary Tuberculosis (TB) in a Region with High TB and HIV Prevalence”. Plos One1 (2016): e0147933.

Citation

Citation: Laure Stella Ghoma Linguissi., et al. “Sputum Quality Challenges the Point of Care Diagnostic System of Pulmonary Tuberculosis in the Republic of Congo ”. Acta Scientific Microbiology 4.7 (2021): 04-10.

Copyright

Copyright: © 2021 Laure Stella Ghoma Linguissi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.