TUBERCULOSIS

INTERNATIONAL STANDARDS
FOR
Tuberculosis Care

Developed by the Tuberculosis Coalition for

Technical Assistance (TBCTA)

WHO, CDC, ATS,KNCV, IUATLD

 Standards for Diagnosis
Standard 1
• All persons with otherwise unexplained productive cough
lasting two–threeweeks or more should be evaluated for
tuberculosis.
Standard 2
• All patients (adults, adolescents, and children who are
capable of producing sputum) suspected of having
pulmonary tuberculosis should have at least two, and
preferably three, sputum specimens obtained for
microscopic examination.
• When possible, at least one early morning specimen
should be obtained.
Lanjutan…

Standard 3
• For all patients (adults, adolescents, and children)
suspected of having extrapulmonary tuberculosis,
appropriate specimens from the suspected sites of
involvement should be obtained for microscopy and
where facilities and resources are available, for culture
and histopathological examination.

Standard 4
• All persons with chest radiographic findings suggestive
of tuberculosis should have sputum specimens
submitted for microbiological examination.
Lanjutan…

Standard 5

• The diagnosis of sputum smear-negative pulmonary

tuberculosis should be based on the following criteria: at
least three negative sputum smears (including at least
one early morning specimen); chest radiography findings
consistent with tuberculosis; and lack of response to a
trial of broadspectrum antimicrobial agents.
(NOTE: Because the fluoroquinolones are active against
M. tuberculosis complex and, thus, may cause transient
improvement in persons with tuberculosis, they should
be avoided.)

• For such patients, if facilities for culture are available,

sputum cultures should be obtained. In persons with
known or suspected HIV infection, the diagnostic
evaluation should be expedited.
Lanjutan…

Standard 6

• The diagnosis of intrathoracic (i.e., pulmonary, pleural,

and mediastinal or hilar lymph node) tuberculosis in
symptomatic children with negative sputum smears
should be based on the finding of chest radiographic
abnormalities consistent with tuberculosis and either a
history of exposure to an infectious case or evidence of
tuberculosis infection (positive tuberculin skin test or
interferon gamma release assay).
• For such patients, if facilities for culture are available,
sputum specimens should be obtained(by expectoration,
gastric washings, or induced sputum) for culture.
 Sputum Examination
• Pulmonary TB is diagnosed by visualization of
AFB (Acid-fast bacillus) on sputum smear and
isolation of the organism from a culture of the
sputum

• Most laboratories currently use auramine-

rhodamine or auramine O to stain the sputum,
allowing scanning for fluoressence as opposed
to Ziehl-Neelsen stain
 Lanjutan……….

• Concentrating sputum specimens and

obtaining a larger quantity of sputum
(≥ 5ml) have both been shown to increase
the probability of visualizing organisms

• Conventional teaching is that sputum

specimens should be obtained on three
consecutive days and that first morning
specimens have the highest yield
Interpretasi Pemeriksaan Dahak
• BTA POSITIF apabila :
3 x pemeriksaan positip atau
2 x pemeriksaan positip; 1 x pemeriksaan negatif
Pemeriksaan BTA:
• 1x positif, 2x negatif  Ulang BTA 3X
• Jika : 1x positif, 2x negatif BTA POSITIF
• Jika : 3x negatif  BTA NEGATIF
 Pemeriksaan mikroskopis
Rekomendasi WHO : Skala IUATLD

• Tidak ditemukan BTA dalam 100 lapangan

pandang  Negatif
• Ditemukan 1 – 9 BTA : tulis jumlah kuman
• Ditemukan 10–99 BTA : 1 +
• Ditemukan 1 – 10 BTA dalam 1 lapang
pandangan : 2 +
• Ditemukan >10 BTA : 3+
 PEMERIKSAAN ULANG DAHAK

K1 : 1 MINGGU SEBELUM AKHIR BULAN KE 2, 5 DAN

AKHIR TX
K2 : 1 MINGGU SEBELUM AKHIR BULAN KE 3, 7 DAN
AKHIR TX
K3 : - AKHIR BULAN KE 2 DAN AKHIR TX
SPUTUM SAMPLING
Tuberculosis Suspect
Patient

Inayati Habib
 THE AIM

• Obtain eligible sputum specimen to

determine the etiology of lower respiratory
tract infection
• The microorganism will be identified by
microscopic examination
 REQUIREMENT
• Sputum should really come from lungs and
must be collected correctly
• Equipment :
Pot with wide opening and the lid/cover
can be tightly closed, with minimal volume
25 ml
IDEAL SPUTUM POT
Procedure of Sputum Sampling
• 3-time sampling :SPS ( random on the 1st day,
morning 2nd day & random on the 2nd day)
• Collect the specimen in outdoor so that an
infectious droplet can be diluted good ventilation
• Ask the patient to close her/his mouth when
coughing
• Don’t stand in front of the patient when
collecting the specimen
Procedure of Sputum Sampling

Don’t Collect the sputum at these places :

• Laboratory room
• Toilet/ Rest room
• Waiting room
• Registration room
• Rooms with bad ventilation
 Procedure Sputum Sampling

• Complete the identity form

• Give label of the patient’s name and date
of sampling: on the side of pot; not the lid.
• The patient must be explained that a good
specimen is the sputum coming from the
lungs, not a secrete from nose/mouth
• If the patient uses prosthetic teeth, it must
be put off and then gargle with water
SPUTUM SAMPLING TECHNIQUE
 Sampling Instruction
• Patient stand up or sit down upright
• Take a breath deeply 2 -3 times and every
blow the breath strongly
• Cough strongly from the inside of chest
• Put the opened pot near the mouth and
then put the sputum to the pot
• Close the pot tightly
 Sampling Result
Good specimen, If :
• Mucous
• Purulent
• Mixed with blood
Bad specimen If :
• Watery
• Bubbling
 CONTOH SPUTUM SAMPLE
Be not disgusted with the sputum sample!
SAMPLE SPECIMEN
 Rejected Sampling

• Broken Pot
• Watery Specimen
• Data on the pot isn’t match with the
formulir
• Specimen with preservatives
• Specimen is collected in the tissue paper
 Location

• Target of Active Selective Case Finding :

- Public around Tb patient with BTA (+)
- Public around Tb patient with BTA (-),
Ro (+), TB extrapulmoner
- Publics around PKTB
• Motivate the public → want to be
treatment
 Thank You for your attention
We hope You will get a Good sputum
sample