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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting
PLoS ONE, Volume 7, No. 12, Article e51336, Year 2012
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Description
Background: The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya. Methods: PTB smear-negative adult suspects were included in a prospective diagnostic study (2009-2011). In addition, program data (2008-2009) were retrospectively analysed. At the first consultation, clinical examination, chest X-ray, and sputum culture (Thin-Layer-Agar and Lowenstein-Jensen) were performed. Patients not started on TB treatment were clinically re-assessed after antibiotic course. The algorithm performance was calculated using culture as reference standard. Results: 380 patients were included prospectively and 406 analyzed retrospectively. Culture was positive for MTB in 17.5% (61/348) and 21.8% (72/330) of cases. Sensitivity of the clinical-radiological algorithm was 55.0% and 31.9% in the prospective study and the program data analysis, respectively. Specificity, positive and negative predictive values were 72.9%, 29.7% and 88.6% in the prospective study and 79.8%, 30.7% and 80.8% in the program data analysis. Performing culture increased the number of confirmed TB patients started on treatment by 43.3% in the prospective study and by 44.4% in the program data analysis. Median time to treatment of confirmed TB patients was 6 days in the prospective study and 27 days in the retrospective study. Inter-reader agreement for X-ray interpretation between the study clinician and a radiologist was low (Kappa coefficient = 0.11, 95%CI: 0.09-0.12). In a multivariate logistic analysis, past TB history, number of symptoms and signs at the clinical exam were independently associated with risk of overtreatment. Conclusion: The clinical-radiological algorithm is suboptimal to diagnose smear-negative PTB. Culture increases significantly the proportion of confirmed TB cases started on treatment. Better access to rapid MTB culture and development of new diagnostic tests is necessary. © 2012 Huerga et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3526594/bin/pone.0051336.s001.pdf
Authors & Co-Authors
Huerga, Helena
France, Paris
Clinical Research Department
Varaine, Francis F.V.
Switzerland, Geneva
Medecins Sans Frontieres
Okwaro, Eric
Switzerland, Geneva
Medecins Sans Frontieres
Bastard, Mathieu
France, Paris
Clinical Research Department
Ardizzoni, Elisa
Switzerland, Geneva
Medecins Sans Frontieres
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Sitienei, Joseph K.
Kenya, Nairobi
Ministry of Health Nairobi
Chakaya, Jeremiah Muhwa
Kenya, Nairobi
Kenya Medical Research Institute
Bonnet, Maryline M.B.
France, Paris
Clinical Research Department
Statistics
Citations: 34
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0051336
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
Kenya