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In 2015, there were an estimated 10.4 million new tuberculosis (TB) cases worldwide, 1.4 million TB deaths, and 480,000 new multidrug-resistant TB cases, according to the WHO report.1 Early diagnosis and immediate initiation of treatment are essential for an effective TB control program. Delay in diagnosis is significant to both disease prognosis at the individual level and transmission within the community.2 To date, several new rapid TB tests (such as Xpert MTB/RIF Ultra, Real time-PCR) have been developed.3 However, sputum smear remains the only readily available TB diagnostic test throughout most of the low-income and middle-income countries.
The National Institute for Health and Care Excellence guideline on TB recommends that multiple sputum samples (at least three, with one early morning sample) were collected for TB microscopy for patients with suspected pulmonary TB (PTB).4 Similar recommendation was made in China.5 However, in Brazil, two sputum samples, including one morning sputum sample, was recommended.6 Remarkably, these recommendations did not contain specific implications on performing multiple smears in 1 day or on different days for PTB. The Shandong Provincial Chest Hospital (SPCH) is a provincial TB referral hospital of approximately 800 beds. Each year, about 1000 patients with TB were diagnosed, with positive results on acid-fast bacilli (AFB) sputum smear examination. The SPCH TB reference laboratory had been accredited by ISO15189 in 2010 and is participating in an external …
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