Md. Sirajul Islam , S. M. Mostofa Kamal, Md. Shamim Hossain,Mousomi Choudhury, Rumana Shams, Ohiuddin Ahmed,Sujan Kumar Sarker , Md. Shahedur Rahman Khan,Bashir Ahmed, Md. Naimul Hoque, Biswas Akhtar Hossain,Md. Rashidul Hassan, SM Abdur Razzaque

Abstract:
Setting: National Tuberculosis Reference Laboratory (NTRL), National Institute
of Diseases of the Chest and Hospital (NIDCH), Bangladesh.
Background: Smear microscopy is still the gold standard for diagnosis of
pulmonary tuberculosis in high burden countries like Bangladesh. Though WHO
recommended 2 smear (spot and morning) examinations, but still there is no
study regarding this experience in Bangladesh.
Objective: This retrospective study was carried to see effectiveness of morning
and spot smear examination for diagnosis of pulmonary tuberculosis in Bangladesh.
Patients and methods: All patients attending in and out patient departments
of NIDCH with respiratory symptoms and or abnormal chest X-rays provided
three sputum samples each for acid-fast bacilli smear microscopy were considered.
Systematic external quality assurance was done by designated EQA center as per
national tuberculosis control program guideline. A total of 16,144 TB suspects
submitted three samples on two consecutive days (spot, early morning, spot) had
been considered for this study between January 2013 and December 2013. Smears
were prepared and stained by Auramine O staining method under LED
Fluorescence Microscopy as per standard operating procedure.
Results: Out of total 48432 smears examined a total of 4476 smears including 1806
cases were positive. The smear and case positivity rate were 9.24% and 11.1%
respectively. Total 3 samples were positive in 1069 cases. Only 1st and 2nd samples
detected 486 cases, 1st and 3rd 27 cases and 2nd & 3rd 19 cases only. 1st sample alone
detected 160 cases, 2nd sample alone 31 cases and 3rd sample 14 cases. Therefore it is
evident that spot and early morning sample will be enough for the diagnosis of
pulmonary tuberculosis.
Conclusion: This retrospective analysis from a high burden laboratory indicated
that spot and early morning smears examination will be sufficient for routine sputum
microscopy.This observation therefore correlative with the WHO recommendation.

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