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Copmparative Study of The Characteristics Of Sputum

Positive & Sputum Negative Pulmonarry Tuberculosis

Patients In Alturky Hospitals Submitted in Partial
Fulfillment of the requerment for the
Degree of master of Infectious diseases & tropical
medicine at University of medical science & technology
_Khartoum _ Sugdan _2010
Prepared By

Dr/Rifaat Hassan A. Khatir
Supervised by

Dr/Haithum Benjawi
Medicine Department
University of Medical Science & Technology

Tuberculosis (TB) is a bacterial disease spreads by
infectious air borne droplets containing
Mycobacterium tuberculosis
(occasionally Mycobacterium bovis or africanum)
(Koch, 1932). Once the organism is inhaled, it travels
via the airways to the pulmonary parenchyma
where it
is deposited. Although the organism may be
deposited in
any lobe, a predilection for the lower lobes exists
The organism is ingested by alveolar macrophages,
which then attempt to phagocytoze the bacilli. As a
of the natural defenses of the tubercle bacillus,
macrophages may be unsuccessful in attempting
to completely
destroy the bacilli, which then lie dormant within

the macrophage. As a consequence, bacilli often

remain viable
within the macrophages in immunocompetent
Subsequently, bacilli may travel via the pulmonary
lymphatics, or they may enter the vascular system
and seed
distant sites such as the liver, spleen, or bone
(Tara, 2005).
In most immunocompetent individuals,
are successful in containing the bacilli, and the
infection is
self-limited and often subclinical. The contained
in immunocompetent hosts is called primary
In some patients, pulmonary macrophages are
unable to
contain the bacilli and are overwhelmed, leading to
a clinically
apparent infection. This is more common in
who are immunocompromised, notably the
population with
.HIV/AIDS. (Tara, 2005)

This form of tuberculosis is called progressive

tuberculosis. Patients with progressive primary
may present with pulmonary manifestations (often
with miliary tuberculosis) or with manifestations of
or disseminated disease (Tara, 2005).

Patients who are exposed to T.B bacilli for the first

time have pathologic, roentgenologic, and clinical
different from those who have reactivation of
previous disease.
As a consequence, it is logical to consider the
processes under the separate headings of primary
and postprimary
tuberculosis (Fraser et al., 1994)
Approximately 80% of tuberculosis patients have
pulmonary disease and the remainder have
disease with or without pulmonary component.
HIV-coinfected persons, this association is
drastically altered
and may even be reversed. The sites where
tuberculosis is most commonly seen, in declining
order of frequency, are the lymph nodes, pleura,
tract, and the bones and joints. Meningeal
accounts for approximately 1% of cases (Niederman
et al., 2001)
Postprimary (reactivation) tuberculosis is seen in
in whom the initial infection was contained
by the pulmonary macrophages, with bacilli
viable within the macrophages. Infection results
the host's immune status (T cells) is compromised.

form may appear in the elderly population, for

.(Tara, 2005 )

Multi-drug-resistant tuberculosis (MDR-TB) is an

increasing global problem, the extent & burden of
varies significantly from country to country &
region to region
(Ormerod, 2005).
The prevalence rate of new cases of multidrugresistant
tuberculosis (MDR-TB) was 2.2% while that of
the previously treated tuberculous cases, which
were discovered
to be multi-drug-resistant, was 38%. (WHO, 2004)
A patient is determined to have a MDR-TB only
through laboratory confirmation of in vitro
resistance to at
least Isoniazid & Rifampicin (WHO, 2005).
More than eight million people develop active TB
annually, and approximately two million die from
the disease
each year. The WHO estimate that there are more
15 million people living with TB. In 2003, out of
8.8 million new TB cases worldwide, 3.9 million
diagnosed by laboratory testing and 674,000 also
HIV+ve. An estimated 1.7 million people died of TB

2003, 22 % of whom were co-infected with HIV.

with active TB who receive no treatment can infect
an average
of 10 to 15 people annually. Although TB is curable,
it kills 5000 people every day, 98% of deaths are in
world affecting mostly young adults in their most
productive years. (WHO TB report, 2005

In 2007, 5.5 million TB cases were notified by DO

TS programmes (99% of total case notifications).
This included
2.6 million smear-positive cases. The case
rate of new smear-positive cases under DOTS (that
is, the
percentage of estimated incident cases that were
and treated in DOTS programmes) was 63%, a
small increase
from 62% in 2006 but still 7% short of the target of
70% first set for 2000 (and later reset to 2005)
REPORT, 2009)
Based on surveillance and survey data, WHO
that 9.27 million new cases of TB occurred in 2007
(139 per 100 000 population), compared with 9.24
new cases (140 per 100 000 population) in 2006.
Of these
9.27 million new cases, an estimated 44% or 4.1

(61 per 100 000 population) were new smearpositive cases

(WHO REPORT, 2009)
Taking a glimpse of the situation in Egypt,
to the WHO, in 2007, the estimated incidence of TB
(all forms) is 15873 cases. The estimated
prevalence of TB
cases (all forms) is 27 per 100000 population. The
annual incidence of new TB cases (all forms) is 21
per 100000 population and 9 per 100000 for smear
TB cases. The mortality rate is 2 per 100000
HIV +ve) and _ 1 per 100000 HIV +ve cases , the
of which is _ 1 per 100000 as well. (WHO REPORT,
The WHO targets are that by 2015: The global
of TB (per capita prevalence and death rates) will
reduced by 50% relative to 1990 levels. By 2050:
global incidence of active TB will be less than 1
case per
million population per year (WHO REPORT, 2009)

Having a capacity of over 600 beds with over 75%

occupied most of the days of the year and being a

center for all upper Egypt, Giza chest hospital has

ranked among the most important chest centers in
and hence was chosen to be the venue for the
present study.

BACKGROUND:The aim of this study is to review the tuberculous

cases seen in outpatient clinic of Natioal Tuberculosis
Programme in Alturky hospital during the year period
(1/1/2011 31/12/2011)
in evaluation of Characteristics Of Sputum Positive &
Sputum Negative as acomperative study.

OBJETIVES:General :Copmparative Study of The Characteristics Of Sputum

Positive & Sputum Negative Pulmonarry Tuberculosis


1-Study of sputum positive prevalence among the

2- prevalence of the patient who remains sputum positive
after two months.
3- Characteristics of patients of Sputum positive positive
versus Sputum negative .
4- Characteristics of X-ray among study population.


A retrospective cross sectional study involving collection of

data of
the tuberculous patients from the records Natioal
Tuberculosis Programme in Alturky hospital .
Giza chest hospital has 14 wards divided as follows:
- Nine wards for males and 4 for females.
- One pediatric ward.
Data will be collected and managed as follows:
1. The total number of patients admitted to the hospital
in the period 2005-2009.

2. Dividing patients into tuberculous cases and

cases with calculation of their percent of
total cases admitted each year in the aforementioned

3. Results of direct smear sputum examination for acidfast bacilli of tuberculous cases admitted to the
hospital during the period of the study.
4. Results of the culture for acid-fast bacilli, if done, of
tuberculous cases and their percentage per total
cases admitted to the hospital during the
period of the study.
5. Classification of the tuberculous cases according to
the site i.e pulmonary and extrapulmonary.
6. Classification of the tuberculous cases according to
the age and sex of the patient.
7. Classification of the patients according to patient
category i.e. New case, relapsed, defaulter, treatment
8. Classification of the patients according to treatment
category i.e. CAT I, CAT II, and CAT III
9. Classification of the patients according to the results
of their sputum examination on discharge.
The results will be analyzed, tabulated and discussed

Fraser, Par (1994): Synopsis of Diseases of The Chest,
Second edition, p. 317
Koch, R. (1932): Die Aetiologie der Tuberculose, a translation
by Berna and Max Pinner with an introduction by Allen
K. Krause. Am Rev. Tubercle; 25: 285. Cited from
Croften and Douglass Fifth edition, vol. 2 Chapter 16
Michael S. Niederman, George A. Sarosi, Jeffrey Glassroth
(2001): Respiratory Infection, Second edition, p. 475,

Ormerod LP (2005): Multidrug-resistant tuberculosis
(MDR-TB): epidemiology, Prevention, and treatment. Br
Med Bull; 73-74:17-24.
Tara M Catanzano, MD(2005), Department of Diagnostic
Radiology, Yale University School of Medicine Lung,
Primary Tuberculosis - September 9, 2005
World Health Organization (2004): Global Tuberculosis
Control: Surveillance, planning, financing;
(WHO/HTM/TB/2004.331). Geneva: WHO.
World Health Organization (2005): Global Tuberculosis
Control: Surveillance, Planning, Financing.
(WHO/HTM/TB2005.349). Geneva: WHO
WHO, Tuberculosis the Global Burden, Sept.2005.
WHO REPORT 2009: Global Tuberculosis Control; p2, 7, 241