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Relative Versus Absolute Noncontagiousness of Respiratory Tuberculosis on Treatment

Published online by Cambridge University Press:  02 January 2015

Richard Long ,
Karen Bochar ,
Sylvia Chomyc ,
James Talbot ,
James Barrie ,
Dennis Kunimoto  and
Peter Tilley
Richard Long*
Affiliation:
Departments of Medicine, Radiology, and Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Karen Bochar
Affiliation:
Departments of Medicine, Radiology, and Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Sylvia Chomyc
Affiliation:
Departments of Medicine, Radiology, and Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
James Talbot
Affiliation:
Departments of Medicine, Radiology, and Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
James Barrie
Affiliation:
Departments of Medicine, Radiology, and Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Dennis Kunimoto
Affiliation:
Departments of Medicine, Radiology, and Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Peter Tilley
Affiliation:
Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
*
Department of Medicine, University of Alberta Hospital, Room 2E4.21, Walter Mackenzie Centre, 8440 -112 Street, Edmonton, Alberta, CanadaT6G 2B7
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Abstract

Objective:

To assess the validity of current estimates of the noncontagiousness of sputum smear-positive respiratory tuberculosis (TB) on treatment.

Design:

A descriptive analysis of the mycobacteriologic response to treatment.

Setting:

A TB inpatient unit of a Canadian hospital.

Patients:

Thirty-two HIV-seronegative patients with moderate to advanced sputum smear-positive respiratory TB were treated with uninterrupted, directly observed, weight-adjusted isoniazid, rifampin, and pyrazinamide. Each patient's initial isolate was drug susceptible and each patient's sputum mycobacteriology was systematically followed until 3 consecutive sputum smears were negative on 3 separate days.

Results:

The time to smear conversion varied remarkably (range, 8 to 115 days; average, 46 days) and was influenced by sputum sampling frequency. Only 3 patients (9.4%) had smear conversions by 14 days and only 8 (25%) had smear conversions by 21 days, the average time it took for drug susceptibility test results to become available. During the first 21 days of treatment, the semiquantitative sputum smear score decreased rapidly and the time to detection of positive cultures doubled. Within the time to smear conversion, virtually all smear-positive specimens (98%) were culture positive and only 34% of the patients had culture conversions (ie, 3 consecutive negative cultures).

Conclusion:

Current estimates of the noncontagiousness of sputum smear-positive respiratory TB on treatment (for 14 days, for 21 days, or until smear conversion) are estimates of relative noncontagiousness. They do not signal absolute noncontagiousness (culture conversion). Semiquantitative smear and time-to-detection data suggest that respiratory isolation beyond 21 days of optimal treatment should be selective.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 11 , November 2003 , pp. 831 - 838
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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