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ASSESSMENT OF DIAGNOSIS OF PULMONARY TUBERCULOSIS BY SPUTUM MICROSCOPY IN A DISTRICT TUBERCULOSIS PROGRAMME

An infectious case of pulmonary tuberculosis is diagnosed by demonstrating tubercle bacilli in sputum. The laboratory methods available for this purpose are sputum microscopy, isolation of tubercle bacilli in culture followed by identification of the bacilli and animal pathogenicity tests. Evidence based on all the three methods establishes bacteriological diagnosis beyond any doubt, but even economically advanced countries may not consider such an elaborate procedure essential for routine diagnosis. Very often sputum microscopy alone is considered sufficient for diagnosis, when combined with clinical findings. Therefore a realistic and economical approach for developing countries would be to provide only facilities for sputum microscopy | Ind. J. Tub. 1971 28 1 10-21 Reprinted f from The Indian Journal of Tuberculosis Vol.XVIII No1 ASSESSMENT OF DIAGNOSIS OF PULMONARY TUBERCULOSIS BY SPUTUM MICROSCOPY IN A DISTRICT TUBERCULOSIS PROGRAMME K.P.RAO S. S NAIR N. NAGANATHAN AND R.RAJALAKSHMI From National Tuberculosis Institute Bangalore Introduction An infectious case of pulmonary tuberculosis is diagnosed by demonstrating tubercle bacilli in sputum. The laboratory methods available for this purpose are sputum microscopy isolation of tubercle bacilli in culture followed by identification of the bacilli and animal pathogenicity tests. Evidence based on all the three methods establishes bacteriological diagnosis beyond any doubt but even economically advanced countries may not consider such an elaborate procedure essential for routine diagnosis. Very often sputum microscopy alone is considered sufficient for diagnosis when combined with clinical findings. Therefore a realistic and economical approach for developing countries would be to provide only facilities for sputum microscopy. One of the basic principles of the Indian District Tuberculosis Programme DTP 1 is to offer diagnosis by sputum microscopy to persons presenting at any general health institution with complaints of symptoms such as cough for 2 weeks or more pain in chest fever and haemoptysis here-in-after called symptomatics . In the programme non specialised staff of general health institutions perform diagnostic and treatment activities for tuberculosis which are coordinated and supervised by a few specialised staff from District Tuberculosis Centre DTC . These non-specialised staff of general health institutions have therefore to be trained in microscopy by the staff of the DTC. In actual practice the efficiency of diagnosis by microscopy will depend upon the skill aptitude experience and conscientiousness of the staff trained. Besides their multiple responsibilities training environment and the competence of the trainers the distribution