Under the National Tuberculosis Elimination Programme (NTEP), a 34-year-old man presents with cough of 3 weeks and weight loss. Which diagnostic test is recommended as the UNIVERSAL UPFRONT test for all presumptive pulmonary TB patients, replacing sputum smear microscopy as the initial diagnostic tool?

• A Sputum smear microscopy by Ziehl-Neelsen stain
• B Chest radiograph followed by culture on LJ medium
• C Nucleic acid amplification test (CBNAAT/TrueNat) ✓
• D Tuberculin skin test with chest radiograph

Explanation

NTEP moved to Universal Drug Susceptibility Testing, making NAAT (CBNAAT/TrueNat) the initial diagnostic test for every presumptive TB patient, since it detects Mycobacterium tuberculosis and rifampicin resistance within about 2 hours. Smear microscopy was retained only where NAAT is unavailable or as a follow-up tool for monitoring response. Culture remains the gold standard but takes weeks and is not an upfront test. The tuberculin skin test has no role in diagnosing active TB.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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