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Sputum Smear Examination of Adult Tuberculosis Patients Admitted in National Institute of Diseases of the Chest and Hospital (NIDCH)

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Sputum Smear Examination of Adult Tuberculosis Patients Admitted in National Institute of Diseases of the Chest and Hospital (NIDCH) Sputum smear examination of adult tuberculosis patients admitted in National Institute of Diseases of the Chest and Hospital (NIDCH) A thesis report submitted to the Department of Pharmacy, East West University, Bangladesh, in partial fulfillment of the course of Pharmaceutical Research (PHRM 404) for the degree of Bachelor of Pharmacy Submitted by Sanjida Halim Topa ID: 2008-3-70-046 Submission date: 10 July, 2012 Supervised by Dr. Sufia Islam Associate Professor, Department of Pharmacy East West University This research paper is dedicated to my beloved parents i Certificate Declaration by the Research Instructor and Department Chairperson 10 July, 2012 It is pleasure to certify that the research paper entitled “Sputum smear examination of adult tuberculosis patients admitted in National Institute of Diseases of the Chest and Hospital (NIDCH)” is prepared by Sanjida Halim Topa, a student of the Department of Pharmacy, East West University, Dhaka. She prepared the paper under my supervision. This is her original work. Dr. Sufia Islam Chairperson Department of Pharmacy East West University ii Acknowledgements All praise to the Almighty, who has made all things in my life possible. It is Him who has sustained me throughout the course of my study. I would like to extend my sincere thanks to the East West University for giving me the opportunity to conduct this study under supervision of my honorable research instructor, Dr. Sufia Islam for her scholarly guidance from the very beginning till the end of this study. I would also like to thank my research co-workers Tasnuva Tamanna and Rabita Israt whose assistance during this study aided in the process of easing my workload. I am very grateful to my friends of department of Pharmacy for encouraging me to accomplish this study. Signature of the candidate Sanjida Halim Topa iii Abstract Objective: The objective of this study was to assess the improvement of the adult tuberculosis patients admitted in National Institute of Diseases of the Chest and Hospital (NIDCH) using AFB microscopic examination. Materials and methods: The study had been conducted among adult TB patients admitted in NIDCH, Dhaka. There were 21 adult patients in this study. The study had been started with preparing a questionnaire to assemble all the necessary information related to TB disease. All of the patients in this study were suffering from pulmonary TB. The existence of this fatal disease among these patients had been confirmed after performing AFB microscopic test. Before performing the AFB microscopic test, a verbal consent from all of the patients was collected. After confirmation of the pulmonary TB, they had been started to take anti-TB drugs. Among these 21 patients, only 7 patients had been included in the 2nd AFB microscopic examination due to some limitations. The outcomes of these two tests were examined to assess the rate of progression of the patients. The hematological report of all the patients were also assessed during the study period to observe other associated risks as well as their health condition due to the presence of TB disease among the patients. Results: In the 2nd AFB microscopic examination of this study, there were only 3 patients among 7 follow up patients showing all negative results. This indicates the success of the treatment among these 3 patients (43%). AFB microscopic results of remaining 4 patients (57%) were still positive showing the presence of Mycobacterium tuberculosis in the sputum. AFB microscopic results of rest of the patients were not negative as they were improving in a slow rate. Therefore, they were responsing slowly towards anti-TB drugs. Another important finding of this study was, there were only 7 patients (33%) present in the 2nd AFB microscopic examination, but in TB disease routine checkup is very crucial to observe the improvement rate. This low percentage indicates the carelessness among the patients. Conclusion: The result demonstrates that proper management of tuberculosis is indeed to rule out this deadly disease from the country. This study can proceed further to have more comprehensible results. iv Table of Content TOPIC NAME PAGE NUMBER CHAPTER 1: INTRODUCTION 1-34 1.1 Tuberculosis 1 1.2. Causative agents 2 1.3. Cell structure of Mycobacterium tuberculosis 2-3 1.4. Transmission of Mycobacterium tuberculosis 3-5 1.5. Pathogenesis of TB 5-7 1.6. Classification of TB 8-15 1.7. Persons at increased risk for progression of LTBI to TB disease 15 1.8. Clinical features of TB 15-17 1.9. Factors influencing clinical features of TB 17 1.10. Diagnosis of TB 17-27 1.11. Treatment of TB 28-31 1.12. Worldwide epidemiology of tuberculosis 31-33 1.13. Significance of study with TB in Bangladesh: 33-34 CHAPTER 2: METHODOLOGY 35-36 2. Methodology 35 2.1. Study place 35 2.2. Inclusion criteria 35 v TOPIC NAME PAGE NUMBER 2.3. Exclusion criteria 35-36 2.4. Study type 36 2.5. Study period 36 2.6. Sample size 36 2.7. Sampling technique 36 2.8. Study population 36 2.9. Data analysis 36 CHAPTER 3: RESULTS AND DISCUSSION 33-55 3.1. Socio-demographic history 37-40 3.2. Patients’ smoking history 40-41 3.3. Risk factors among the patients 41 3.4. Diagnosis results 41 3.4.1. Microscopy results 41-44 3.4.2. Results of follow-up patients: 44-49 3.4.3. Hematological report 49-51 3.5. Discussion 52-53 CHAPTER 4: CONCLUSION 54 Annexes 55-59 References 60-64 vi LIST OF TABLES TABLE NAME OF THE TABLES PAGE NUMBER NUMBER 1.1 Factors that determine the probability of M. tuberculosis 4 transmission 1.2 Environmental factors enhancing the probability of M. tuberculosis 5 to be transmitted 1.3 Proximity, frequency and the length of time that enhance the 5 probability that M. tuberculosis will be transmitted 1.4. Grading of microscopy smears 22 1.5 Quantitation scale for mycobacterial growth on agar plates 25 1.6 Standardized treatment regimen for each diagnostic category 29 (Adults) 1.7 Category 1 30 1.8 Category II 30 1.9 Worldwide data of tuberculosis by WHO, 2010 32 3.1 Distribution of patients according to their gender 37 3.2 Distribution of the patients according to different weight ranges 38 3.3 Area of residence of the patients 39 3.4 Patients’ awareness about the disease 40 3.5 Vaccination status among the patients 40 3.6 Patients’ smoking history 40 3.7 Risk factors among the patients 41 3.8 1st specimen of 1st test in adult male patients 41 3.9 2nd specimen of 1st test in adult male patients 42 vii TABLE NAME OF THE TABLES PAGE NUMBER NUMBER 3.10 3rd specimen of 1st test in adult male patients 43 3.11 1st AFB microscopic results of patient number 1 44 3.12 2nd follow up AFB microscopic results of patient number 1 45 3.13 1st AFB microscopic result of patient number 2 45 3.14 2nd follow up AFB microscopic results of patient number 2 45 3.15 1st AFB microscopic result of patient number 3 46 3.16 2nd AFB microscopic result of patient number 3 46 3.17 1st AFB microscopic result of patient number 4 46 3.18 2nd AFB microscopic result of patient number 4 47 3.19 1st AFB microscopic result of patient number 5 47 3.20 2nd AFB microscopic result of patient number 5 47 3.21 1st AFB microscopic result of patient number 6 48 3.22 2nd AFB microscopic result of patient number 6 48 3.23 1st AFB microscopic result of patient number 7 48 3.24 2nd AFB microscopic result of patient number 7 48 3.25 Hematological report of male patients 49 3.26 Hematological report of female patients 50 viii LIST OF FIGURES FIGURE NAME OF THE FIGURES PAGE NUMBER NUMBER 1.1 Mycobacterium tuberculosis 2 1.2 Transmission of Mycobacterium tuberculosis 3 1.3 Pathogenesis of LTBI and TB disease 7 1.4 Latent Tuberculosis Infection (LTBI) 9 1.5 Sputum container 19 1.6 Ziehl Neelsen staining procedure 21 1.7 Mantoux tuberculin skin test 24 1.8 Chest X- ray and CT Scan 25 1.9 TB prevalence around the world 32 1.10 Case detection rate in TB in Bangladesh 33 1.11 Treatment success rate in TB in Bangladesh 33 3.1 The number of patient with different age ranges 37 3.2 The education level of patients 38 3.3 Distribution of patients according to their living status 39 3.4 1st specimen of 1st test in adult female patients 42 3.5 2nd specimen of 1st test in adult female patients 43 3.6 3rd specimen of 1st test in adult female patients 44 ix List of Abbreviations AFB Acid Fast Bacillus AIDS Acquired Immunodeficiency Syndrome CBC Complete Blood Count DOTS Directly Observed Treatment Short Course E Ethambutol ESR Erythrocyte Sedimentation Rate FDC Fixed-Dose Combinations H Isoniazid HIV Human Immunodeficiency Virus PTB Pulmonary Tuberculosis R Rifampicin S Streptomycin SS+ Sputum Smear Positive SS- Sputum Smear Negative TB Tuberculosis WHO World Health Organization Z Pyrazinamide 1 Chapter 1 1. Introduction 1.1 Tuberculosis According to World Health Organization (WHO), “Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.” Another definition in reference to Medilexicon`s medical dictionary, tuberculosis is “A specific disease caused by infection with Mycobacterium tuberculosis, the tubercle bacillus, which can affect almost any tissue or organ of the body, the most common site of the disease being the lungs.” Therefore, TB primarily affects the lungs, but it can also affect other organs, like, central nervous system, lymphatic system and circulatory system among others.
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