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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Laboratory diagnosis of pulmonary tuberculosis in TB and HIV endemic settings and the contribution of real time PCR for M. tuberculosis in bronchoalveolar lavage fluid
Tropical Medicine and International Health, Volume 12, No. 10, Year 2007
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Description
Background: Tuberculosis (TB) in Africa is increasing because of the human immunodeficiency virus (HIV) epidemic, and in HIV/AIDS patients it presents atypically. Pulmonary tuberculosis (PTB) in Africa is mainly diagnosed clinically, by chest radiograph or by sputum smear for acid fast bacilli (AFB). Methods: We evaluated in 120 HIV-infected patients with chest infection the diagnostic accuracy of AFB smear of sputum and bronchoalveolar lavage (BAL) fluid, sputum Mycobacterium tuberculosis (MTB) culture, real-time PCR and MycoDot® serological test, using MTB culture of BAL fluid as gold standard. We correlated PCR cycle threshold values (CT) to the culture results. Retrospectively, we evaluated the development of active TB in patients with positive PCR but negative culture. Results: Culture of BAL fluid identified 28 patients with PTB. Fifty-six patients could not produce adequate sputum. Sputum AFB smear and the serological test had sensitivities of 66.7% and 0%, respectively. PCR with CT 40 was positive in 73 patients, 27 of whom were also TB culture positive (96.4% sensitivity and 52.3% specificity of PCR). PCR with CT 32 had sensitivity of 85.7% and specificity of 90.9% to diagnose PTB in BAL. No patients with positive PCR but negative culture developed active TB during 18 months follow-up. Conclusion: In these HIV-infected patients, AFB smear and serology had very low sensitivities. PCR of BAL with CT value 32 had improved specificity to diagnose active PTB. A prospective follow-up study is warranted in TB/HIV endemic settings, applying real time PCR to both sputum and BAL. © 2007 Blackwell Publishing Ltd.
Authors & Co-Authors
Kibiki, Gibson S.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Mulder, Bert
Netherlands, Enschede
Laboratory for Medical Microbiology and Public Health
van der Ven, André J.A.M.
Netherlands, Nijmegen
Radboud University Medical Center
Sam, Noel E.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Boeree, Martin Johan
Netherlands, Nijmegen
Radboud University Medical Center
van der Zanden, Adri G.M.
Netherlands, Apeldoorn
Gelre Ziekenhuizen
Dolmans, Wil M.V.W.M.V.
Netherlands, Nijmegen
Radboud University Medical Center
Statistics
Citations: 48
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1111/j.1365-3156.2007.01907.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Infectious Diseases
Study Design
Cohort Study