Suspect management Dr Magdy Fawzy NTP, Egypt PAL coordinator
Who is the TB suspect? Any person, who presents with symptoms suggestive of tuberculosis: • cough of long duration. • hemoptysis; • general symptoms such as weight loss, sweating, and tiredness; chest pain; and fever.
1. identifying TB suspects, health workers should ask every adult (aged 15 years or more) who comes to the health facility: • Do you have cough? • For how long have you been coughing?
Key information • Respiratory symptoms are very common: 5 – 30% of patients in PHC setting.
Key information • Among respiratory diseases: • 80% to 90% are ARIs • 10 to 20% are CRDs • 2% and less are pulmonary TB
2. List the TB suspect in the Register • The Register of TB Suspects is a record of: • all patients identified as TB suspects at the health facility, and • all sputumsamples sent to the laboratory.
3. Collect sputum for smear examination. 4. Enhance TB suspect’s cooperation Explain to the patient the reason for sputum examination and that examining sputum under a microscope is the best way to determine whether there are tubercle bacilli in the lungs. 5. Fill out Request for Sputum Examination. 6. Collect sputum samples from the TB suspect. How?
7.When the laboratory results are received, record results in the Register of TB Suspects and decide on appropriate action • If two (or three) specimens are positive • If only one specimen is positive. • If all specimens are negative
OP TB suspects TBS sent to lab TBS tested +ve pt +ve pt registered Flow from suspect to patient Q: Where we may miss cases? A:We need to investigate the flow of the OP attendee from OP till diagnosis as TB case.
What should be done? • "TB suspect" should not be considered as a disease category but as a cut off from which respiratory patients should be screened for TB • All respiratory patients with symptoms more than 2-3 weeks should be screened for TB whatever the established diagnosis, including CRD cases (asthma, COPD/CB, and others) • Establishment of a tracking system to monitor: • Identification, in PHC; of respiratory patients eligible for TB screening. • Follow-up of patients who were sent for DSM to LAB.