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OP Kapoor
 

In the past, most of the physicians would ask for the routine stool examination, nearly as often as urine examination. I remember that off and on, the stool showed ova of round worms, or other helminths. More often majority of stool examination reported occasional cysts of E hystolitica.

Since many years, we have been using a single dose of albendazole 400 mg to treat all the nematodes. So now-a-days we rarely see patients having round worms or other worms. Similarly, metronidazole is being used by every practitioner for multiple indications, including infection of H pylorides, hence intestinal amoebiasis has nearly disappeared from specialist consulting practice.

Now that amoebiasis is diagnosed by sigmoidoscopy and mucosal biopsies, it has been realised that these cysts, which were reported in the past, were most possibly of Entamoeba dispar. Entamoeba dispar is a normal commensal and does not cause any disease in the body and cannot be differentiated from a cyst of E hystolytica.

Finally, the only stool test which we would ask for is stool for occult blood. However, a single test of stool positive for occult blood has no value. Only if it is positive on 3 consecutive days should the upper and lower GI Endoscopy be asked for, unless the patient is taking drugs like Aspirin.

IMPROVED DIAGNOSIS OF TUBERCULOSIS BY BETTER SPUTUM QUALITY

However, bacteria must be present in high concentrations to be detected, typically more than 5000-10000/mL. HIV-infected patients usually have a low bacterial burden, which compromises the severity of microscopy in areas where HIV is prevalent.

Second, not many women might know the difference between saliva and sputum, or be comfortable to cough deeply and expectorate. Third, for biological reasons, women with tuberculosis might have less inflammation and a lower frequency of productive cough than men.

Bachti Alisjahbana, Reinout van Crevel, The Lancet, 2007; 369 : 1907-9.

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

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