Tuberc Respir Dis.  2017 Jan;80(1):27-34. 10.4046/trd.2017.80.1.27.

Duration of Pulmonary Tuberculosis Infectiousness under Adequate Therapy, as Assessed Using Induced Sputum Samples

• Ko Y
• Shin JH
• Lee HK
• Lee YS
• Lee SY
• Park SY
• Mo EK
• Kim C
• Park YB

• KMID: 2396338
• DOI: http://doi.org/10.4046/trd.2017.80.1.27

Abstract

BACKGROUND
A sputum culture is the most reliable indicator of the infectiousness of pulmonary tuberculosis (PTB); however, a spontaneous sputum specimen may not be suitable. The aim of this study was to evaluate the infectious period in patients with non-drug-resistant (DR) PTB receiving adequate standard chemotherapy, using induced sputum (IS) specimens.
METHODS
We evaluated the duration of infectiousness of PTB using a retrospective cohort design.
RESULTS
Among the 35 patients with PTB, 22 were smear-positive. The rates of IS culture positivity from baseline to the sixth week of anti-tuberculosis medication in the smear-positive PTB group were 100%, 100%, 91%, 73%, 36%, and 18%, respectively. For smear-positive PTB cases, the median time of conversion to culture negativity was 35.0 days (range, 28.0-42.0 days). In the smear-negative PTB group (n=13), the weekly rates of positive IS culture were 100%, 77%, 39%, 8%, 0%, and 0%, respectively, and the median time to conversion to culture-negative was 21.0 days (range, 17.5-28.0 days).
CONCLUSION
The infectiousness of PTB, under adequate therapy, may persist longer than previously reported, even in patients with non-DR PTB.

Keyword

Tuberculosis, Pulmonary; Mycobacterium tuberculosis; Infectious Disease Incubation Period; Induced Sputum

MeSH Terms

Cohort Studies
Drug Therapy
Humans
Infectious Disease Incubation Period
Mycobacterium tuberculosis
Retrospective Studies
Sputum*
Tuberculosis, Pulmonary*

Figure

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  Figure 1 Trends of positive-to-negative culture conversion assessed by weekly serial induced sputum after adequate standard anti-tuberculosis medication. Positive-to-negative culture conversion trend based on acid-fast bacilli (AFB) smear status, as assessed using weekly induced sputum specimens. (A) Overall trend of positive-to-negative culture conversion (n=35). (B) Trend of positive-to-negative culture conversion in smear-positive pulmonary tuberculosis (n=22). (C) Trend of positive-to-negative culture conversion in smear-negative pulmonary tuberculosis (n=13). LM: liquid media; SM: solid media.

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  Figure 2 Kaplan-Meier estimates for overall culture positivity according to acid-fast bacilli (AFB) smear status for 35 pulmonary tuberculosis (TB) patients.

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  Figure 3 The rate of positive-to-negative smear and culture conversion assessed by induced sputum after 4 weeks of adequate standard anti-tubuerculosis medication. (A) Overall of positive-to-negative culture conversion (n=83). (B) Positive-to-negative culture conversion in smear-positive pulmonary tuberculosis (n=31). (C) Positive-to-negative culture conversion in smear-negative pulmonary tuberculosis (n=52). AFB: acid-fast bacilli; LM: liquid media; SM: solid media.

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