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1.  High yield of culture-based diagnosis in a TB-endemic setting 
BMC Infectious Diseases  2012;12:218.
Background
In most of the world, microbiologic diagnosis of tuberculosis (TB) is limited to microscopy. Recent guidelines recommend culture-based diagnosis where feasible.
Methods
In order to evaluate the relative and absolute incremental diagnostic yield of culture-based diagnosis in a high-incidence community in Cape Town, South Africa, subjects evaluated for suspected TB had their samples processed for microscopy and culture over a 21 month period.
Results
For 2537 suspect episodes with 2 smears and 2 cultures done, 20.0% (508) had at least one positive smear and 29.9% (760) had at least one positive culture. One culture yielded 1.8 times more cases as 1 smear (relative yield), or an increase of 12.0% (absolute yield). Based on the latter value, the number of cultures needed to diagnose (NND) one extra case of TB was 8, compared to 19 if second specimens were submitted for microscopy.
Conclusion
In a high-burden setting, the introduction of culture can markedly increase TB diagnosis over microscopy. The concept of number needed to diagnose can help in comparing incremental yield of diagnosis methods. Although new promising diagnostic molecular methods are being implemented, TB culture is still the gold standard.
doi:10.1186/1471-2334-12-218
PMCID: PMC3482573  PMID: 22978323
Tuberculosis; Diagnosis; Culture; Microscopy
2.  Malaria Epidemics and Surveillance Systems in Canada 
Emerging Infectious Diseases  2004;10(7):1195-1201.
Malaria surveillance data are evaluated for causes of epidemics in Canada.
In the past decade, fluctuations in numbers of imported malaria cases have been seen in Canada. In 1997 to 1998, malaria case numbers more than doubled before returning to normal. This increase was not seen in any other industrialized country. The Canadian federal malaria surveillance system collects insufficient data to interpret these fluctuations. Using local (sentinel), provincial, federal, and international malaria surveillance data, we evaluate and interpret these fluctuations. Several epidemics are described. With an ever-increasing immigrant and refugee population of tropical origin, improved surveillance will be necessary to guide public health prevention policy and practice. The Canadian experience is likely to be generalizable to other industrialized countries where malaria is a reportable disease within a passive surveillance system.
doi:10.3201/eid1007.030826
PMCID: PMC3323336  PMID: 15324537
malaria; surveillance; epidemic; Canada; perspective

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