National Tuberculosis Seminar Haroi,Vietnam,February,1997

Problems of Diagnosis of Tuberculosis in NTP

Toru Mori, M D (Research Institute of Tuberculosis)

1. Smear positive TB a top priority in CF

〇 Epidemiological significance

〇 Medical relevance - Prognosis

〇 Operational feasibility

〇 Passive case detection scheme

〇 PHC setting

〇 Motivation of the cases

〇 Excessive treatment load (?)

2. Quality of Smear examination in TB Diagnosis

〇 Sensitivity and Specificity of tests

〇 False negative cases and False positive cases

〇 Principle of Three times examinations

3. Diagnosing and Treating Smear negative TB

a) Ways of diagnosis : Culture and X-ray

〇 Technical and instrumental limitations

〇 False negative culture?

〇 Active or inactive lesion ?

〇 Operational limitations; Distribution of diagnostic centers, Cost

b) Medical and epidemiological relevance

〇 Prognosis of the smear negative cases, if not treated

〇 Potential as sources of infection

〇 Problem under HIV epidemics

〇 Psychology

c) Cost/Effectiveness/Benefit Considerations

〇 Compare strategies

〇 Treat now

〇 Wait until smear positively

〇 Compare cost difference and effectiveness difference

〇 according to diagnostic accuracy

〇 according to cost differential

d) Conclusion

〇 Concentrate on smear positive tuberculosis, with good QC

〇 Practice a good "Wait and re-examine" policy

〇 Establish a good referral system with quality X-ray / culture

CEA of treatment of Smear (-)ve TB Cases (1) (Prelimirary, Mori)

◆ Treatment of Smear (-)ve TB Patients;

- Strategy 1. Start chemotherapy Now

- Strategy 2. Wait until developing to (+) and treat

◆ Related Factors;

- Cost for treating (+)ve and (-)ve cases

- Dx accuracy of (-)ve TB Prob. developing to (+)ve TB

- Infectivity of (+)ve cases

- Natural course of (+)ve cases

- Case-finding effectiveness of (+)ve cases

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