Johanna Kessel, Elif Göymen, Timo Wolf, Nils Wetzstein, Claus Philippe Küpper-Tetzel, Pia Behrens, Frauke Borgans, Ümniye Balaban, Michael Hogardt, Thomas A. Wichelhaus, Christoph Stephan
- Highlights
• Open pulmonary tuberculosis patient discharge policy was not reviewed for decades.
• After smear-negativity conversion, substantial cultural positivity may remain.
• It remains unclear, whether smear-negative patients still may be infective.
• The clinical relevance of this finding warrants further investigation.
Abstract
Objectives: Patients with open pulmonary tuberculosis (opTB) are subject to strict isolation rules. Sputum smear microscopy is used to determine infectivity, but sensitivity is lower than for culture. This study aimed to investigate the clinical relevance of this mismatch in contemporary settings.
Methods: Differential results between microscopy and culture were determined at the time of microscopic sputum conversion, from all patients with opTB between 01/2013 and 12/2017. In addition, data on HIV, multi/extensive drug-resistant TB status, time to smear- and cultural-negativity conversion were analyzed; and a Kaplan-Meier curve was developed.
Results: Of 118 patients with opTB, 58 had demographic data available for microbiological and clinical follow-up analysis; among these, 26 (44.8%) had still at least one positive culture result. Median time from opTB-treatment initiation to full microscopic sputum- or culture conversion, was 16.5 days (range 2-105), and 20 days (1-105), respectively (median difference: +3.5 days). Sixteen days after de-isolation, >90% had converted culturally. HIV- or multi/extensive drug-resistant TB status did not impact conversion time.
Conclusion: When patients with opTB were de-isolated after 3 negative sputum smear microscopy tests, a substantial part still revealed cultural growth of Mycobacterium tuberculosis complex, but it remains unclear, whether smear-negative and culturally-positive individuals on therapy are really infective. Thus, the clinical relevance of this finding warrants further investigation.
MetadatenAuthor: | Johanna KesselGND, Elif GöymenGND, Timo WolfORCiDGND, Nils WetzsteinORCiDGND, Claus Philippe Küpper-TetzelORCiDGND, Pia BehrensGND, Frauke BorgansGND, Ümniye BalabanORCiDGND, Michael HogardtORCiDGND, Thomas A. WichelhausORCiD, Christoph StephanORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-790545 |
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DOI: | https://doi.org/10.1016/j.ijid.2023.07.009 |
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ISSN: | 1201-9712 |
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Parent Title (English): | International Journal of Infectious Diseases |
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Publisher: | Elsevier |
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Place of publication: | Amsterdam |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2023/07/22 |
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Date of first Publication: | 2023/07/16 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2024/03/24 |
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Tag: | Culture positive; De-isolation; Open pulmonary tuberculosis; Sputum smear-negative; TB-therapy |
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Volume: | 134 |
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Page Number: | 4 |
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First Page: | 269 |
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Last Page: | 272 |
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HeBIS-PPN: | 52195746X |
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Institutes: | Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - Namensnennung 4.0 |
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