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Tuberculosis Research and Treatment
Volume 2012 (2012), Article ID 970203, 6 pages
Clinical Study

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

1Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
2Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
3Iganga/Mayuge Demographic Surveillance Sites, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
4KNCV Tuberculosis Foundation, The Hague and CINIMA, Academic Medical Centre, Parkstraat 17, 2514 JD The Hague, The Netherlands

Received 17 October 2012; Revised 19 November 2012; Accepted 20 November 2012

Academic Editor: Carlo Garzelli

Copyright © 2012 Willy Ssengooba et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% ( ) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection.