Tuberculosis in the Torres Strait: the lady doth test too much

Introduction: Smear-positive pulmonary tuberculosis (PTB) requires rapid diagnosis and treatment to prevent ongoing transmission. Collection of two sputum specimens is considered the minimum requirement for PTB but current guidelines in Torres Strait Islands, Australia, recommend three specimens; this frequently delays initiation. Methods: A retrospective study was performed ascertain diagnostic yield collected Islands. The assessed demographics characteristics all cases diagnosed between 2000 2018, 143 patients from whom at least had been prior commencement. Incremental cumulative calculated each specimen. Data were further analysed using binary logistic regression examine association selected a smear-positive acid-fast bacilli (AFB) result. Results: Overall, AFB detected first or second specimen 97 101 that smear positive. result more common (odds ratio 2.84, 95% confidence interval 1.08–7.46) Papua New Guinea nationals compared Australian born patients. Of 429 samples collected, 76 (18%) poor quality smear-negative results significant (p<0.01). Among cases, 5/42 (12%) consecutive specimens. most collection modality adults voluntary expectoration; done 391/429 (91%) collected. Alternative methods mainly used children; induced 1/429 (0.2%), gastric aspirate 26/429 (6%) nasopharyngeal 7/429 (1.6%). Errors with labelling, packaging transportation occurred 44 15 Conclusion: Two good ensure adequate third should only be negative who have persistent symptoms. Ideally, decentralised Xpert Ultra® frontline test remote settings, especially settings like Islands high rates drug-resistant TB.