%0 Journal Article
%T Active Case Finding of Pulmonary Tuberculosis through Screening of Respiratory Symptomatics Using Sputum Microscopy: Is It Time to Change the Paradigm?
%A Eva Carolina del Portillo-Mustieles
%A Rafael Laniado-Labor¨ªn
%J Tuberculosis Research and Treatment
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/312824
%X Background. One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with PTB. Although this is programmatic strategy for active case finding, its yield is not well known. Objective. To determine the yield of pulmonary tuberculosis active case finding through the screening of respiratory symptomatic (RS) patients at a general hospital. Methods. RS patients were defined as subjects complaining of cough and/or sputum for a period of 2 or more weeks. Outpatients and their companions were approached while they waited in the outpatient care areas of the hospital to detect RS. Two samples from different days or 2 samples taken 2 hours apart on the same day were collected. Results. 122 RS patients were identified. Fifty-seven patients (46.7%) had at least one sputum sample analyzed. Three patients presented a positive smear and 2 were culture positive; neither had upper airway symptoms. None of the patients with productive cough and upper airway symptoms had a positive smear ( ). Only 19 (33.3%) returned to the laboratory to retrieve their results. Conclusion. Current strategy to screen RS patients based only on clinical data has a low compliance. Specific strategies to increase compliance (removal of barriers, incentives, etc.) should be implemented. 1. Introduction Tuberculosis (TB) represents one of the world¡¯s public health greatest challenges. One key factor for its control is to stop the chain of transmission in the community by diagnosing and treating cases as early as possible. The planning and implementation of efficient tuberculosis control programs is crucial, and the strategies that compose them must be submitted to constant evaluation and refining. One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with PTB (in M¨¦xico for screening purposes defined as productive cough lasting more than two weeks), known also as respiratory symptomatic patients (RS). It is estimated that in regions with high prevalence of PTB from 5 to 10% of the patients that seek outpatient medical services are RS, and, of those, from 1 to 5% are smear positive [1]. The most recent data from Mexico [2] shows a PTB incidence of 42.1/100,000 in the state of Baja California, the highest rate in the country; Tijuana the largest city in the state has an annual rate between 50 and 60 cases per 100,000. Most of the cases were detected passively at outpatient health services and hospitals; only 3.6%
%U http://www.hindawi.com/journals/trt/2013/312824/