PT  - JOURNAL ARTICLE
AU  - Spada, Valentina
AU  - Ostera, Salvatore
AU  - Vertuccio, Cono
AU  - Atzeni, Elena
AU  - Ligia, Giovanni Paolo
AU  - Sortino, Elisabetta
AU  - Fois, Alessandro Giuseppe
AU  - Pirina, Pietro
TI  - Epidemiology of smear-negative pulmonary tuberculosis in Sardinia (Italy) from 2000 to 2009: Role of ex-adiuvantibus treatment
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p4146
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p4146.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p4146.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Introduction: Pulmonary tuberculosis (TB) management is vexed when sputum microscopy is negative for M.Tuberculosis in patients with positive Mantoux and symptoms/Chest X-Ray suggestives for TB, especially to decide whether to start treatment or wait for the culture results. Several studies have shown that many smear/culture-negative patients will develop a bacteriologically positive disease later.Aim: To assess the percentage of ex-adiuvantibus treatment that has been given and to find out if it should be recommended.Methods: We have collected data from medical records of adult patients discharged with TB diagnosis by the Sardinian reference health centers (AOUSL of Sassari, Cagliari, Nuoro) from 2000 to 2009, including acid-fast microscopy by Ziehl-Neelsen and culture examination (Bactec 460–MGIT 960 TB, Lowenstein-Jensen).Results: We have notified 686 TB cases (incidence 4/100000 population, half the national rate) of which 80% lung TB: 71% smear positives, 29% smear negatives. Among smear negative patients 36% were treated after a positive culture result, 1.8% although it was negative and 42% before culture, turned out positive in 84.8% and negative in 15.2% of patients; in 22% of cases there weren't any data on culture and follow-up.Conclusion: The percentage of smear negative TB was lower in Sardinia (29%) than at national level (40%). An ex-adiuvantibus therapy would been necessary at least in 70% of cases with a clinical-radiological picture suggestive for TB, but only 34% started treatment before culture result delaying disease recovery. So in these subjects therapy should not be postponed because a negative smear doesn't exclude a TB diagnosis.