Screening under RNTCP emphasizes on:
Ans. a. Sputum microscopy (Ref: Park 23/e p427, 662, 22/e p394)Screening under RNTCP emphasizes on sputum microscopy.'Over-reliance on chest X-ray was a draw back of National Tuberculosis Programme (NTP), which was over come by Revised National Tuberculosis Control Programme (RNTCP) which started diagnosing patient by sputum microscopy.'-Park 22/e p394'A nation-wide network of RNTCP quality assured designated sputum smear microscopy laboratories has been set up, providing appropriate, available, affordable and accessible diagnostic services for TB suspects and cases. These laboratories carry out sputum microscopy with External Quality Assessment (EQA), and Drug Resistance Surveillance (DRS) related activities. Number of spec imen(s) required for diagnosis of smear positive pulmonary Tuberculosis: TWO; Spot sputum specimen (Day 1) and Morning sputum specimen (Day 2). - Park 22/e p394New Tuberculosis Diagnosis (RNTCP) Guidelines in IndiaObjectives:Achievement of at least 85 per cent cure rate of infectious cases of tuberculosis: through DOTS involving peripheral health functionariesAugmentation of case finding activities through quality sputum microscopy to detect at least 70 per cent of estimated cases.History of RNTCP:RNTCP (based on DOTS strategy), began as a pilot in 1993 and was launched as a national program in 1997Rapid RNTCP expansion began in late 1998By 24th March 2006. the entire country was covered under DOTS, covering 1114 million peopleInfrastructure:The RNTCP designated 'Microscopy Centre' is established for approx. 100,000 populationQ (50,000 in hilly and mountainous areas)Senior TB Laboratory Supervisor (STLS)One STLS for every 5 microscopy centersOne STLS per 5 lac populationQSTLS rechecks all +ve slides and 10% of all --ve slidesDiagnosis in RNTCP:In RNTCP, mainstay of diagnosis is Sputum microscopy; the sputum smears are stained for acid fast Bacilli (AFB) with 'Ziehl Neelson (ZN) Stain'Decolorizer: 25% sulphuric acidCounter-stainQ; 0.1% Loeffier 's methylene blue (or 1% picric acid or 0.2% malachite green).Number of specimen(s) required for diagnosis of smear positive pulmonary TB: TwoSpot sputum specimen (Day 1)Morning sputum specimen (Day 2)Tuberculosis Suspect: Any person with cough 2 weeks or moreDiagnosis of Tuberculosis:None sputum positive: DoubtfulOne sputum positive: Sputum positive pulmonary TBTwo sputum positive: Sputum positive pulmonary TBManagement of clients:None sputum positive: Give antibiotics for 10-14 daysCough relieved: Non- tuberculosis personCough persists: Repeat two sputum smear examinationsNone sputum positive: X-ray chestFindings suggestive of TB: Sputum negative TB; Start ATTNo findings suggestive of TB: Non- tuberculosis personOne sputum positive: Sputum positive pulmonary TB: Start ATTTwo sputum positive: Sputum positive pulmonary TB; Start ATTDifferences in National Tuberculosis Programme (NTP) and RNTCP NTP, 1962RNTCPObjective* Early diagnosis and treatmentQ* Breaking chain of transmissionQOperational targets* Not definedQ* Cure rate > 85%Q* Case finding > 70%QStrategy* SCC supervisedQ* ConventionalQ* DOTSQ* Uninterrupted drug supplyQDiagnosis* More emphasis on X-raysQ* Mainly sputum microscopyQ
Sputum microscopy
Chest X-ray
PCR
Sputum culture
Health Programmes in India