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Ensuring accurate sputum microscopy results is paramount to maintain optimal sensitivity and specificity of sputum microscopy.

In this regard, External Quality Assurance (EQA) is an important aspect of the National TB Elimination Programme (NTEP) Laboratory Network. Different levels of EQA activities are undertaken to ensure that the system follows a standard protocol and remains efficient. The timely completion of EQA activities is important.

Fluorescence Microscopy is a newer and better type of microscopy where the TB bacteria are stained using a fluorescent dye using the property of Acid Fastness. The dye will fluoresce when illuminated by UV light. When the UV light source is an LED Lamp, it is called LED fluorescent microscopy.

Here the bacilli appear as slender bright yellow fluorescent rods, standing out clearly against a dark background, as can be seen in the figure below.

The procedure will be the same for Laboratory Technician (LT) at Culture and Drug Susceptibility Testing (C & DST) lab for preparation and validation of reagents.

Each laboratory should have a Quality Control (QC) slide examination register.

At the District level the Senior TB Laboratory Supervisor (STLS) should record the QC slides (positive and negative) results in the register kept after preparation of each batch of reagents at the District TB Unit.

While doing sputum smear microscopy for presumptive TB patients, it is essential that the correct specimen part is tested for microscopy.

During smear preparation, each Laboratory Technician (LT) should identify a part of specimen that is either mucoid or purulent or mucopurulent, instead of thin saliva (Figure).

Acid-fast Bacilli (AFB) tend to be more in the purulent part of the smear.

Figure: Best Portion Selection for Performing Sputum Microscopy

As Tuberculosis (TB) infection spread in the form of droplet infection, healthcare workers in the TB laboratory setting need to follow standard safety precautions to prevent themselves from getting the TB infection.

Some of the safety precautions in the TB laboratory setting are as follows:

Induced sputum is considered in a situation where a person is unable to provide sputum sample in sufficient quantity for Tuberculosis (TB) diagnostic test. This situation is more evident in children.

Palliative care is provided by a team of physicians, nurses and other health professionals who work together with the primary care physician and referred specialists (or for patients who don't have those, hospital or hospice staff) to provide an extra layer of support. Hence, palliative care is to be initiated by the Nodal Drug-resistant TB Centres (NDR-TBCs) in the states.

There are 2 main modalities of palliative care under the National TB Elimination Program (NTEP):

Longer oral Multi (M)/ Extensive Drug-resistant (XDR) -TB treatment is specified with a definite regime and duration.

Regimen: (18-20) Levofloxacin (Lfx), Bedaquiline (Bdq) (6 months or longer), Linezolid^# (Lzd), Clofazimine (Cfz), Cycloserine (Cs)​​ (^# dose of Lzd will be tapered to 300 mg after the initial 6–8 months of treatment)​

Once a presumptive TB patient is identified, the patient is enrolled online by a healthcare worker or doctor in Nikshay online portal. For diagnosis of Tuberculosis, the treating physician can request a test utilizing the request test option of Nikshay online portal. The step-by-step approach for test request is as follows:

Step 0: Go to the Patients Page.

Step 1: Select the “Tests” tab.

Step 2: Click the “Add Test” button.

Drug Susceptibility Testing (DST) refers to in-vitro testing using either of the phenotypic methods to determine susceptibility. Drug Resistance Testing (DRT) refers to in-vitro testing using genotypic methods (molecular techniques) to determine resistance.