Next step of Management of smear +ve but negative cha X-ray of TB presumptive pt

Slide repoing The number of bacilli seen in a smear reflects disease severity and patient infectivity. Therefore, it is impoant to record the number of bacilli seen on each smear. Laboratory technicians should examine both the sputum samples from each TB suspect. They must record the result of each sputum sample with the laboratory reference number in the laboratory register and on the sputum request form. Results as indicated above are made available to the clinician who can then categorize the patient. It is advised that the smear examined by one microscopist should not exceed 20 per day as visual fatigue leads to a deterioration of reading quality. One positive specimen out of the two is enough to declare a patient as smear positive TB. Smear positive TB is fuher classified as new or retreatment cases, based on their previous treatment history, and appropriate therapy is prescribed. Patients in whom both specimens are smear negative should be prescribed symptomatic treatment and broad-spectrum antibiotic for 10-14 days. In such casesantibiotics such as fluoroquinolones (ciprofloxacin, ofloxacin, etc.), rifampicin or streptomycin, which are active against TB, should not be used. Most patients are likely to improve with antibiotics if they are not suffering from TB. If the symptoms persist after a course of broad-spectrum antibiotic, repeat sputum smear examination (2 samples) must be done for such patients. If one or more smears are positive, the patient is diagnosed as having smear-positive pulmonary TB. If none of the repeat sputum specimen is positive, a chest X-ray is taken, and if findings of the X-ray are consistent with pulmonary TB, the patient is diagnosed as a case of sputum-negative pulmonary TB. Sputum smear microscopy for tubercle bacilli is positive when there are at least 10,000 organisms present per ml of sputum. The sputum smear positivity rate in TB/HIV patient depends on the degree of immunocompromise. If the degree of immunocompromise is mild, the likelihood of positive sputum smear is similar to HIV negative patient. If immunocompromise is severe, the likelihood of positive sputum smear is decreased because of decreased inflammation in lungs Ref : Park 23rd edition Pgno : 183