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  • Screening and Diagnostic Technology in NTEP

    Learning Objectives

    Screening and Diagnostic technologies are tests that objectively identify cases under various definitions.

    They are used at specific time points for one or more indications, such as identification and diagnosis of TB infection, presumptive TB, TB disease, routine followup and diagnosis of drug resistance, as per the various diagnostic algorithms.

    They are classified based on the technology as Microscopy, Phenotypic, genotypic, Radiological and Histopathological tests. Other tests may be used for identifying TB infection such as Mantoux and IGRA.

    There are a few serological tests developed for the use of diagnosis of TB, but are banned due to their unreliability.

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Content

Screening technology in NTEP: 

  • Sputum smear microscopy

  • Chest X-ray   

  • Tuberculin Skin Test (TST) 

  • Histopathology and other tissue-based tests

 

Diagnostic Technology in NTEP: 

Tools for microbiological confirmation of Tuberculosis (TB) under the programme. Acceptable methods for microbiological diagnosis of TB are:  

  • Sputum Smear Microscopy (for AFB) 

  1. Zeihl-Neelsen Staining 

  2. Fluorescence staining  

  • Culture:  

  1. Solid (Lowenstein Jensen) media  

  2. Automated Liquid culture systems e.g., BACTEC MGIT 960, BacT Alert or Versatrek etc. 

  • Drug Sensitivity Testing:  

  1. Modified Proportionate Sensitivity Testing (PST) for MGIT 960 system  

  2. Economic variant of Proportion sensitivity testing (1%) using LJ medium  

  • Rapid molecular diagnostic tests: 

  1. Line Probe Assay (LPA) for MTB complex and detection of RIF & INH resistance (FL LPA) and FQ and SLI resistance (SL LPA)  

  2. Nucleic Acid Amplification Test (NAAT) (CBNAAT/Truenat) 

 

Supportive tools for the clinical diagnosis of TB: 

  1. Chest X-ray and other radiological tests  

  2. Tuberculin Skin Test (TST) 

  3. Interferon Gamma Release Assay (IGRA) and other blood tests 

  4. Histopathology and other tissue-based tests 

  

Resource: 

TRAINING MODULES (1-4) FOR PROGRAMME MANAGERS AND MEDICAL OFFICERS Central TB Division, Ministry of Health and Family Welfare (MoHFW), Government of India 2020 

Assessment: 

  

Question    

Answer 1    

Answer 2    

Answer 3    

Answer 4    

Correct answer    

Correct explanation    

Sputum smear microscopy is the most widely used and acceptable testing tool for diagnosing smear positive pulmonary TB. Ziehl-Neelsen / Fluorescent staining technique is used under the programme.  

 

 True   

 False   

   

   

 1 

Sputum smear microscopy has the following advantages: 

A. Simple, inexpensive, requires minimum training  

B. High specificity C. High reliability with low inter-reader variation  

D. Can be used for diagnosis, monitoring and defining cure  

E. Results are available quickly F. Feasible at peripheral health institutions  

G. Correlates with infectivity in pulmonary TB.

Therefore, this is the key diagnostic tool used for case detection under the programme.
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