Журнал тропических болезней и общественного здравоохранения

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Evaluation of Smear Negative Pulmonary Tuberculosis Before and After Antibiotic Use: The Case of Four Public Health Centers of Addis Ababa, Ethiopia

Shemsu Kedir Juhar

Background: Diagnosis of pulmonary tuberculosis in sputum smear-negative patients is challenging in today ’ s medical practice. As a result, Diagnosis of SNPT mostly supported on clinical and radiographic elements in our country set up.

Methods: A prospective cross-sectional study on the burden of smear-negative pulmonary tuberculosis from a total of 220 suspected pulmonary tuberculosis patients conducted in four public health centers of Addis Ababa, Ethiopia between May 25, 2017, and September 30, 2017. Study participants sputum sample were screened for acid-fast bacilli by direct smear microscopy two times before and after antibiotic administration and demographic data was taken. All smear negative morning sputum samples were further processed for culture using solid Lowenstein-Jensen medium at the St. Peter TB Specialized Hospital TB laboratory. Statistical analysis was done to predict the burden of smearnegative pulmonary tuberculosis.

Results: 206 (93.6%) patients with suspected pulmonary tuberculosis have had negative smear results for acid-fast bacilli. 16 (7.76%) and 14 (6.8%) patients whose smears were negative for acid-fast bacilli found to be positive for Mycobacterium culture before and after taking broad-spectrum antibiotics respectively. Abnormal chest X-ray findings were observed in 25 (54.3%) out of 46 patients. Night sweat and weight loss have shown a significant association with culture-confirmed SNPT.

Conclusion: The study showed 92.2% smear-negative pulmonary tuberculosis cases were still etiologically unexplained by culture. Therefore, there is a need to improve practice on sputum sample collection, processing and using other existing better diagnostic approaches for the diagnosis of SNPT in the Ethiopian setting to avoid a missed diagnosis of patients.