Diagnostic Outcomes After Chest Radiograph Interpretation in Patients With Suspected Tuberculosis and Negative Sputum Smears in a High-Burden Human Immunodeficiency Virus and Tuberculosis Setting

Abstract Background Evaluation of patients with suspected tuberculosis and negative sputum smears for acid-fast bacilli (AFB) is challenging, especially in high human immunodeficiency virus coinfection settings where sputum smears have lower sensitivity for detecting AFB. Methods We examined the utility of chest radiographs for detecting smear-negative pulmonary tuberculosis. Three hundred sixty sputum smear–negative patients who were referred from primary care clinics in the KwaZulu-Natal province of South Africa were evaluated. Chest radiographs were read by experienced pulmonologists using a previously validated Chest X-Ray Reading and Recording System (CRRS). Results Agreement between observers using CRRS was high at 91% with a Cohen’s kappa of 0.64 (95% confidence interval [CI] = 0.52–0.76). Against a reference standard of sputum culture, sensitivity was 93% (95% CI = 86%–97%), whereas specificity was 14% (95% CI = 10%–19%). Performance against clinical diagnosis (following World Health Organization guidelines) was similar with sensitivity of 92% (95% CI = 88%–95%) and specificity of 20% (95% CI = 13%–28%). Conclusion The low specificity of CRRS in this setting indicates poor diagnostic utility for detecting pulmonary tuberculosis.

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Human Immunodeficiency Virus Antibody Testing by Enzyme-Linked Fluorescent and Western Blot Assays Using Serum, Gingival-Crevicular Transudate, and Urine Samples

Journal of Clinical Microbiology ◽

10.1128/jcm.37.4.1100-1106.1999 ◽

1999 ◽

Vol 37 (4) ◽

pp. 1100-1106 ◽

Cited By ~ 22

Author(s):

Prudencio Martínez Martínez ◽

Antonio Rodríguez Torres ◽

Raul Ortiz de Lejarazu ◽

Ana Montoya ◽

José Francisco Martín ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Western Blot ◽

Stage Iv ◽

Urine Samples ◽

World Health ◽

Antibody Detection ◽

Lower Sensitivity ◽

Antibody Testing ◽

Immunodeficiency Virus

The aim of the present study was to evaluate the possible utilization of saliva and urine as alternative samples to serum for the diagnosis of human immunodeficiency virus (HIV) infection. A total of 302 individuals participated in the study: 187 HIV-infected individuals (106 had Centers for Disease Control and Prevention [CDC] stage II infection, 19 had CDC stage III infection, and 62 had CDC stage IV infection) and 115 noninfected persons (46 of the noninfected persons were blood donors and 69 belonged to a group at high risk of HIV infection). Paired saliva and urine samples were taken from each of the participants in the study. The presence of HIV-specific antibodies was detected by an enzyme-linked fluorescent assay (ELFA), and the result was confirmed by Western blot analysis (WB). The ELFA with saliva gave maximum sensitivity and specificity values, while ELFA had lower sensitivity (95.2%) and specificity (97.4%) values for detection of HIV antibody in urine samples. WB with all saliva samples fulfilled the World Health Organization criterion for positivity, while only 96.8% of the urine samples were confirmed to be positive by WB. Among the four reactivity patterns found by WB of these alternative samples, the most frequent included bands against three groups of HIV structural proteins (was ENV, POL, and GAG). The reactivity bands most frequently observed were those for the proteins gp160 and gp120. The least common reactivity band was the band for protein p17. The detection of HIV antibodies in saliva samples by means of ELFA with the possibility of later confirmation by WB makes saliva an alternative to serum for possible use in the diagnosis of infection. In contrast, HIV antibody detection in urine samples by the same methodology (ELFA) could be taken into consideration for use in epidemiological studies.

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Characteristics of pulmonary tuberculosis in HIV seropositive and seronegative patients in a Northeastern region of Brazil

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822004000100012 ◽

2004 ◽

Vol 37 (1) ◽

pp. 46-50 ◽

Cited By ~ 29

Author(s):

Isabella Ramos de Oliveira Liberato ◽

Maria de Fatima P. Militão de Albuquerque ◽

Antônio Roberto Leite Campelo ◽

Heloísa Ramos Lacerda de Melo

Keyword(s):

Pulmonary Tuberculosis ◽

Clinical Laboratory ◽

Sputum Smear ◽

Tuberculosis Patients ◽

Hiv Coinfection ◽

Hiv Virus ◽

Immunodeficiency Virus ◽

Negative Sputum ◽

Reaction Result ◽

Sputum Smear Examination

The aim of this study was to analyse the clinical, epidemiological and bacteriological features present in 60 pulmonary tuberculosis patients who were also infected with human immunodeficiency virus (HIV) and to compare these with 120 TB patients who were not infected with HIV. The patients with pulmonary tuberculosis and HIV coinfection were mostly male (p = 0.001), showed a higher frequency of weight loss >10 kilos (p <0.001), had a higher rate of non-reaction result to the tuberculin skin test (p <0.001), a higher frequency of negative sputum smear examination for acid-fast bacilli (p = 0.001) and negative sputum culture for Mycobacterium tuberculosis (p = 0.001). Treatment failure was more common in those who were HIV positive (p <0.000). No higher frequency of resistance to antituberculosis drugs was found to be associated with TB/HIV coinfection (p = 0.407). Association between extrapulmonary and pulmonary tuberculosis was more frequent in those seropositive to HIV than those without HIV virus, 30% and 1.6% respectively. These findings showed a predominance of atypical clinical laboratory features in co-infected patients, and suggest that health care personnel should consider the possibility this diagnosis.

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Sero-prevalence of human immunodeficiency virus infection among patients with newly diagnosed pulmonary tuberculosis in a teaching hospital in Bauchi, North-Eastern Nigeria

Annals of African Medical Research ◽

10.4081/aamr.2018.28 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Sabiu Abdu Gwalabe ◽

Jacob Dunga ◽

Yusuf Jibrin Bara ◽

Alkali Muhammad ◽

Mustapha Sabo Umar ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Pulmonary Tuberculosis ◽

Hiv Infection ◽

Teaching Hospital ◽

University Teaching ◽

Sputum Smear ◽

Newly Diagnosed ◽

Immunodeficiency Virus ◽

North Eastern ◽

Hiv Antibodies

About a third of the human immunodeficiency virus (HIV) positive population worldwide is co-infected with Mycobacterium tuberculosis. However, data are lacking about the prevalence of HIV among patients with pulmonary tuberculosis (PTB) in a teaching hospital in Bauchi, northeast Nigeria. The aim of this study is to determine the sero-prevalence of HIV among patients with sputum smear positive PTB at Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, Bauchi State, Nigeria. This is a retrospective study review of patients’ medical records diagnosed with sputum smear positive PTB that attended and received treatment at directly observed treatment short course (DOTS) clinic of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, Bauchi State, North-Eastern Nigeria from January, 2015- December, 2017. All the patients were newly diagnosed with sputum smear positive PTB using ZN stain testing of their sputum and screened for HIV antibodies. There were 155 patients studied comprising of 95 (61.29%) males and 60 (38.71%) females. One hundred and twenty (77.42%) patients were seronegative and 35 (22.58%) sero-positive for HIV. Most of the patients were within the ages of 15-54 years with mean age of 34.63±15.55. The sero-prevalence of HIV infection among the patients is 22.58%. Sero-prevalence of HIV is observed to be high among young and married patients with secondary level of education. The sero-prevalence of HIV infection among the patients is relatively lower than those reported in most parts of Nigeria and the sub-Saharan Africa, hence there is still need for continued screening of HIV antibodies among patients with PTB so as to reduce the morbidity and mortality that may result from the coinfection.

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Contribution of Gene-Xpert in the Diagnosis of Negative Microscopy Pulmonary Tuberculosis in Brazzaville, Republic Of Congo

10.47363/jpr/2020(2)110 ◽

2020 ◽

pp. 1-8

Author(s):

Laure Stella Ghoma Linguissi ◽

◽

Clément Armand Nyanga-Koumou ◽

Christ Eya ◽

◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Diagnostic Accuracy ◽

World Health ◽

Sputum Smear ◽

Published Data ◽

National Guidelines ◽

Republic Of Congo ◽

Middle Income ◽

Standard Design ◽

Smear Negative

Setting: Xpert MTB/Rif has become an integral part of tuberculosis diagnostic algorithms in many low- and middle-income countries and no published data was retrieved regarding the diagnostic accuracy of Xpert MTB/RIF in sputum smear-negative pulmonary TB in RoC. Objectives: This study aimed at determining the diagnostic accuracy of Xpert MTB/RIF in diagnosing sputum smear-negative pulmonary tuberculosis keeping AFB microscopy as the gold standard. Design: For 4 months, one morning sputum smear was performed for every TB suspect (cough lasting >3 weeks, as defined in Congolese’s national guidelines) with AFB microscopy and GeneXpert. Results: Of 90 TB suspects for whom AFB microscopy and GeneXpert were performed, 79 (87.78%) sputum smear-negative 17 (21.52%) GeneXpert positive cases were identified. During the study, 11 (12.22%) sputum smear-positive cases were diagnosed. GeneXpert has greatly contributed to increasing the total number of bacteriologically proven cases. Conclusion: These results confirms the utility of GeneXpert in the diagnosis of tuberculosis especially smear negative pulmonary tuberculosis, and demonstrates that the expected number of smear-negative TB cases in Republic of Congo is probably much higher than the World Health Organization’s current annual estimates

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Implementation of the Thin Layer Agar Method for Diagnosis of Smear-Negative Pulmonary Tuberculosis in a Setting with a High Prevalence of Human Immunodeficiency Virus Infection in Homa Bay, Kenya

Journal of Clinical Microbiology ◽

10.1128/jcm.00264-09 ◽

2009 ◽

Vol 47 (8) ◽

pp. 2632-2634 ◽

Cited By ~ 12

Author(s):

A. Martin ◽

P. Munga Waweru ◽

F. Babu Okatch ◽

N. Amondi Ouma ◽

L. Bonte ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Virus Infection ◽

Pulmonary Tuberculosis ◽

Human Immunodeficiency Virus Infection ◽

Thin Layer ◽

Immunodeficiency Virus ◽

High Prevalence ◽

Smear Negative ◽

Agar Method

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Detection of Mycobacterium tuberculosis in smear negative sputum by PCR

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v6i2.19368 ◽

2012 ◽

Vol 6 (2) ◽

pp. 2-6 ◽

Cited By ~ 1

Author(s):

Mohammad Jobayer ◽

SM Shamsuzzaman ◽

Kazi Zulfiquer Mamun

Keyword(s):

Mycobacterium Tuberculosis ◽

Pulmonary Tuberculosis ◽

Accurate Method ◽

Major Health Problem ◽

Major Health ◽

Tuberculosis Patients ◽

Diagnostic Potential ◽

Total Death ◽

Smear Negative ◽

Negative Sputum

Pulmonary tuberculosis is a major health problem in Bangladesh that is responsible for about 7% of total death in a year. This study was conducted to isolate and identify Mycobacterium tuberculosis from sputum and to evaluate the efficacy of PCR as a modern diagnostic tool, for diagnosis of pulmonary tuberculosis, especially in the smear negative cases. One hundred and fifty suspected pulmonary TB patients (male/ female: 97/53) were included in this study. Single morning sputum was collected from each patient and diagnostic potential of PCR was compared with staining and culture. Twenty five (16.7%) sputum were positive by ZN stained smear. Among 125 smear negative samples, 13 (10.4%) yielded growth in culture in LJ media and 21 (16.8%) samples were positive by PCR. The sensitivity and specificity of PCR in smear negative cases was 100% and 92.9% respectively. Mean detection time in PCR was 24 hours. PCR detected M. tuberculosis in 21 smear negative and 9 culture negative samples. For diagnosis of tuberculosis in smear negative cases, PCR directly from sputum was a very sensitive and accurate method. In conclusion, PCR may be done, especially in clinically suspected pulmonary tuberculosis patients who remain negative by conventional methods.DOI: http://dx.doi.org/10.3329/bjmm.v6i2.19368 Bangladesh J Med Microbiol 2012; 06(02): 2-6

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Urine lipoarabinomannan in HIV uninfected, smear negative, symptomatic TB patients: effective sample pretreatment for a sensitive immunoassay and mass spectrometry

Scientific Reports ◽

10.1038/s41598-021-82445-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anita G. Amin ◽

Prithwiraj De ◽

Barbara Graham ◽

Roger I. Calderon ◽

Molly F. Franke ◽

...

Keyword(s):

Limit Of Detection ◽

Sample Pretreatment ◽

Positive Association ◽

Proteinase K ◽

Clinical Samples ◽

Sputum Smear ◽

Smear Negative ◽

Tuberculostearic Acid ◽

Negative Sputum ◽

Adult Culture

AbstractOur study sought to determine whether urine lipoarabinomannan (LAM) could be validated in a sample cohort that consisted mainly of HIV uninfected individuals that presented with tuberculosis symptoms. We evaluated two tests developed in our laboratory, and used them on clinical samples from Lima, Peru where incidence of HIV is low. ELISA analysis was performed on 160 samples (from 140 adult culture-confirmed TB cases and 20 symptomatic TB-negative child controls) using 100 μL of urine after pretreatment with Proteinase K. Two different mouse monoclonal antibodies-CS35 and CHCS9-08 were used individually for capture of urine LAM. Among cases, optical density (OD450) values had a positive association with higher bacillary loads. The 20 controls had negative values (below the limit of detection). The assay correctly identified all samples (97–100% accuracy confidence interval). For an alternate validation of the ELISA results, we analyzed all 160 urine samples using an antibody independent chemoanalytical approach. Samples were called positive only when LAM surrogates—tuberculostearic acid (TBSA) and d-arabinose (d-ara)—were found to be present in similar amounts. All TB cases, including the 40 with a negative sputum smear had LAM in detectable quantities in urine. None of the controls had detectable amounts of LAM. Our study shows that urinary LAM detection is feasible in HIV uninfected, smear negative TB patients.

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Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094623 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4623

Author(s):

Sherali Massavirov ◽

Kristina Akopyan ◽

Fazlkhan Abdugapparov ◽

Ana Ciobanu ◽

Arax Hovhanessyan ◽

...

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Treatment Outcomes ◽

Sputum Smear ◽

People Living With Hiv ◽

Tb Treatment ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Immunodeficiency Virus ◽

Positive Sputum Smear

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management.

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