1. Performance of the 2007 WHO algorithm to diagnose smear-negative pulmonary tuberculosis in a HIV prevalent setting.
- Author
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Huerga H, Varaine F, Okwaro E, Bastard M, Ardizzoni E, Sitienei J, Chakaya J, and Bonnet M
- Subjects
- Adult, Ambulatory Care, Anti-Bacterial Agents therapeutic use, Female, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Mycobacterium tuberculosis drug effects, Mycobacterium tuberculosis growth & development, Mycobacterium tuberculosis physiology, Prevalence, Prospective Studies, Retrospective Studies, Tomography, X-Ray Computed, Tuberculosis, Pulmonary diagnostic imaging, Tuberculosis, Pulmonary drug therapy, Young Adult, Algorithms, HIV Infections complications, HIV Infections epidemiology, Sputum microbiology, Tuberculosis, Pulmonary complications, Tuberculosis, Pulmonary diagnosis, World Health Organization
- Abstract
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.
- Published
- 2012
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