The efficiency of methods of diagnosing pulmonary tuberculosis: An investigation in a chest clinic in algiers

During a four month period 529 patients with respiratory symptoms attended a chest clinic in Algiers. Questioning, sputum examinations, chest x-rays and tuberculin tests were done in all. The results were used to evaluate the relative efficiency of these routine diagnostic measures, alone and in combination. Seventy-one patients (13%) had sputum positive on microscopy (55) or on culture only (16). From the single specimen of sputum collected at the first visit 45 cases (63% of the discovered cases), were detected. If sputum had been examined from only the 222 who complained of haemoptysis, 73% of the 45 cases would have been detected by examining only 42% of the number of smears needed to detect all cases. If sputum had been examined from only those with tuberculin reactions greater than 5 mm. diameter, 91% of the microscopy-positive cases would have been detected with a saving of 20% of sputum examinations. Ninety of the 529 patients had x-rays interpreted as ‘active tuberculosis’. A single specimen of sputum from these 90 patients detected all the 45 microscopy-positive patients-less than 20% of the total smear examinations needed if all patients had sputum examined. In a hypothetical clinic with only microscopy facilities 57% of sputum-positive patients could be detected by examining up to four specimens from only those complaining of haemoptysis-five patients for one positive. If an x-ray apparatus were available 76% could be detected by examining sputum from those with chest x-rays reported ‘active tuberculosis’-less than two patients for one positive. If, in addition, culture facilities were available, 90% could be detected by examining sputum only from the radiographically, ‘active tuberculosis’ group-again less than two patients for one positive. Durant une période de quatre mois, 529 patients se sont présentés dans un dispensaire d'Alger pour des symptomes respiratoires. Chacun d'eux a été soumis à un interrogatoire, ádes examens bacteriologiques de 1'expectoration, à des radiographies et à un test cutané tuberculinique. Les résultats de cette investigation ont été interprétés dans le but d'évaluer l'efficacité relative de ces moyens de diagnostic usuels pris isolément, ou combines entre eux. Soixante et onze consultants (13%) expectoraient des bacilles, reconnus par l'examen microscopique chez 55 d'entre eux, et par la seule culture chez les 16 autres. Quarante cinq cas de tuberculose (63% des cas découverts), ont été trouvé positifs par le seul