Performance of the WHO 2011 TB Symptom Screening Algorithm for Pulmonary TB Diagnosis among HIV-Infected Patients in Gondar University Referral Hospital, Ethiopia

The new WHO 2011 guidelines on TB screening among HIV-infected individuals recommend screening using four TB symptoms (current cough, fever, weight loss, and night sweats). This study aimed to assess the performance of WHO 2011 TB symptom screening algorithm for diagnosing pulmonary TB in HIV patients and identify possible risk factors for TB. Institutional based cross-sectional study was conducted from February 2012 to November 2012. A total of 250 HIV-infected patients aged ≥18 years visiting the University of Gondar Hospital, ART clinic, were enrolled. Information about WHO TB clinical symptoms and other known risk factors for TB was collected using structured questionnaire. Spot-morning-spot sputum samples were collected and direct AFB microscopy, sputum culture, and RD9 molecular typing were performed. Statistical data analysis was performed using SPSS Version 20.0 software. Of 250 study participants, fever was reported in 169 (67.6%), whereas cough and night sweats were reported in 167 (66.8%) and 152 (60.8%), respectively. A total of 11 (4.4%) TB cases were identified. Of these, 82% (9/11) TB patients reported cough, so that the negative predictive value was 98%. In addition, 66% (158/239) TB negative patients reported cough, so that positive predictive value of cough was 5%. According to the new WHOTB symptom screening algorithm, out of 250 HIV-infected persons, 83% (5/6) have been investigated by TB symptom screening and AFB smear microscopy. Therefore, the 2011 WHO TB symptom screening tool for the diagnosis of pulmonary TB is likely to reduce the diagnostic delay and lower TB morbidity and mortality rate particularly in HIV prevalent settings.

Download Full-text

Diagnostic Accuracy of Ziehl-Neelsen Smear Microscopy in Comparison with GeneXpert in Pulmonary Tuberculosis: A Multi-Center Study in Kandahar Province, Afghanistan

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i230299 ◽

2021 ◽

pp. 1-7

Author(s):

Mujeeb Ahmad ◽

Muhammad Haroon Stanikzai ◽

Najeeb Rahimy ◽

Abdul Wahed Wasiq ◽

Hadia Sayam

Keyword(s):

Pulmonary Tuberculosis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Disease Transmission ◽

Predictive Value ◽

Smear Microscopy ◽

Cross Sectional ◽

Pulmonary Tb ◽

Kappa Value

Background: Tuberculosis (TB) is a major global health problem. The early and accurate diagnosis is crucial for disease management and to control disease transmission and the emergence of drug resistance TB. Objectives: This study was carried out to determine the diagnostic accuracy of Ziehl Neelsen (ZN) smear microscopy in comparison with GeneXpert MTB/RIF in pulmonary tuberculosis in Kandahar province, Afghanistan. Methods: This was a facility-based cross-sectional study. We scrutinized TB registers of three health facilities to include patients who had their sputum tested by both ZN smear microscopy and GeneXpert MTB/RIF. We extracted 734 patients’ data registered during January 2019 - June 2020 in a structured form. Kappa value was analyzed using SPSS version 19 software at 95% Confidence Interval (CI). We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of ZN smear microscopy against GeneXpert MTB/RIF. Results: In comparison with GeneXpert as a reference test, ZN smear microscopy has 67.7% (95% CI:63.44%-70.74%) sensitivity and 100% (95% CI:98.74%-100.00%) specificity. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 99.89% (95% CI:99.88%-99.90%), respectively. The agreement between ZN smear microscopy and GeneXpert MTB/RIF results was moderate (70.4%) and the Kappa value was 0.45 (95% CI:0.38-0.59). Conclusion: This study has found high specificity but moderate sensitivity for the diagnosis of pulmonary TB using sputum ZN smear microscopy test. Hence, GeneXpert MTB/RIF test is more accurate and reliable for the diagnosis of pulmonary TB.

Download Full-text

Bladder dysfunction in women with diabetes mellitus

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.6_7.5 ◽

2019 ◽

pp. 34-40

Author(s):

Thi Bich Ngoc Hoang ◽

Hai Thuy Nguyen

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Bladder Dysfunction ◽

Clinical Symptoms ◽

Residual Volume ◽

Cross Sectional ◽

Diabetic Cystopathy ◽

Postvoid Residual ◽

Postvoid Residual Volume

Introduction: Lower urinary tract dysfunctions secondary to type 2 DM are common, chronic and costly disorders. The incidence of diabetic bladder dysfunction was estimated range between 43% and 87% for type 1 and 25% for type 2 diabetes. Ultrasonography is an easy-to-use, fast, safe, non-invasive, painless, pleasant and valuable method of assessing Bladder Post-Void Residual Volume (PVR). Aim: To investigate prevalence of bladder dysfunction and its relation with risk factors, clinical features of diabetic cystopathy in women with diabetes, to identify the values predicting to have postvoid residual volume of the risk factors. Methods: A cross sectional descriptive study, a cohort of 84 female inpatients and outpatients with diabetes mellitus who were treated at Hue University of Medicine and Pharmacy Hospital from 08/2017 to 08/2019 and 84 healthy control subjects were enrolled, the patients were carried out clinical finding, taken blood tests, and estimated postvoid residual volume using 2D ultrasound. Results: the postvoid residual volume was presented in 67 cases (79.80%), the clinical symptoms of diabetic cystopathy were reported in 75% of women with diabetes. Blood glucose, HbA1c, clinical symptoms of diabetic cystopathy, postural hypotension and diabetic peripheral neuropathy were associated with postvoid residual volume. The HbA1c level had a great capability to predict who had postvoid residual volume, at HbA1c cutoff value of 9.1%, Se 65.67%, Sp 94.12%, AUC 0.811, p < 0.001. Conclusion: Bladder dysfunction made up a highly prevalent in women with poor glycemic control. Key words: bladder dysfunction, diabetic cystopathy, bladder postvoid residual volume (PVR)

Download Full-text

Blinded Rechecking of AFB smear Microscopy performance in Selected private health facilities in Tigray, Northern Ethiopia

10.21203/rs.3.rs-38096/v1 ◽

2020 ◽

Author(s):

Letebrhan Weldemhret

Keyword(s):

Predictive Value ◽

Cost Effective ◽

Cross Sectional Study ◽

Health Facilities ◽

Sputum Smear ◽

Smear Microscopy ◽

Northern Ethiopia ◽

Major Error ◽

Cross Sectional ◽

Tigray Region

Abstract Background: Sputum smear microscopy remains the most cost-effective tool for tuberculosis diagnosis and treatment monitoring in resource constrained settings. Random blinded rechecking is a reliable tool to measure and improve smear microscopy. So, this study was intended to assess random blinded rechecking of AFB smear microscopy performance in selected private health facilities in Tigray region, Northern Ethiopia.Methods: A cross sectional study was conducted from April 1st 2017 to May 30, 2017. The data was collected using standard data collection form. Statistical analysis was done using SPSS version 25 and the reading agreement was done using kappa statistics.Results: Of the total 269 blinded rechecked smears, 4.8% was found discrepant findings. The major and minor errors were reported by 2.6% (7/269) and 2.2% (6/269) respectively. Likewise, the major error was reported by 50% (5/10) of health facilities with microscopic center. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the blinded rechecking smears were 87.5%, 98%, 89.7% and 97.8%, respectively with substantial reading agreement, kappa value= 0.80.Conclusions: The overall performance of blinded rechecking was satisfactory with good smear reading agreement. But, the major error reported indicated unacceptable performance. To minimize the discrepancy, private health facilities with tuberculosis smear microscopic center should adhere to national tuberculosis guidelines.

Download Full-text

Missed opportunities for tuberculosis investigation in a municipal hospital in Ghana: evidence from patient exit interviews

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa080 ◽

2020 ◽

Author(s):

Joyce B Der ◽

Daniel J Grint ◽

Clement T Narh ◽

Frank Bonsu ◽

Alison D Grant

Keyword(s):

Multivariable Analysis ◽

Cross Sectional Study ◽

Hiv Positive ◽

Symptom Duration ◽

Hiv Status ◽

Cross Sectional ◽

Missed Opportunities ◽

Tb Treatment ◽

Symptom Screening ◽

Night Sweats

Abstract Background We assessed coverage of symptom screening and sputum testing for tuberculosis (TB) in hospital outpatient clinics in Ghana. Methods In a cross-sectional study, we enrolled adults (≥18 years) exiting the clinics reporting ≥1 TB symptom (cough, fever, night sweats or weight loss). Participants reporting a cough ≥2 weeks or a cough of any duration plus ≥2 other TB symptoms (per national criteria) and those self-reporting HIV-positive status were asked to give sputum for testing with Xpert MTB/RIF. Results We enrolled 581 participants (median age 33 years [IQR: 24–48], 510/581 [87.8%] female). The most common symptoms were fever (348, 59.9%), chest pain (282, 48.5%) and cough (270, 46.5%). 386/581 participants (66.4%) reported symptoms to a healthcare worker, of which 157/386 (40.7%) were eligible for a sputum test per national criteria. Only 31/157 (19.7%) had a sputum test requested. Thirty-two additional participants gave sputum among 41 eligible based on positive HIV status. In multivariable analysis, symptom duration ≥2 weeks (adjusted odds ratio [aOR] 6.99, 95% confidence interval [CI] 2.08–23.51) and previous TB treatment (aOR: 6.25, 95% CI: 2.24–17.48) were the strongest predictors of having a sputum test requested. 6/189 (3.2%) sputum samples had a positive Xpert MTB/RIF result. Conclusion Opportunities for early identification of people with TB are being missed in health facilities in Ghana.

Download Full-text

Performance of LED Fluorescence Microscopy for the Diagnosis of Pulmonary Tuberculosis in HIV Positive Individuals in Addis Ababa, Ethiopia

Tuberculosis Research and Treatment ◽

10.1155/2015/794064 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Konjit Getachew ◽

Tamrat Abebe ◽

Abebaw Kebede ◽

Adane Mihret ◽

Getachew Melkamu

Keyword(s):

Pulmonary Tuberculosis ◽

Predictive Value ◽

Addis Ababa ◽

Sputum Sample ◽

Cross Sectional Study ◽

Hiv Positive ◽

Smear Microscopy ◽

Lower Sensitivity ◽

Cross Sectional ◽

Sensitivity Specificity

Background. Despite its lower sensitivity, smear microscopy remains the main diagnostic method for pulmonary tuberculosis (PTB) in resource-limited countries as TB culturing methods like LJ (Lowenstein-Jensen) are expensive to use as a routine base. This study aimed to evaluate the performance of LED-FM for the diagnosis of PTB in HIV positive individuals.Methods. Cross-sectional study was conducted in Zewditu Memorial Hospital and Teklehaimanot Health Center HIV/ART clinics in Addis Ababa, Ethiopia. Each sample was stained with ZN and Auramine O staining and examined with bright-field microscope and LED-FM microscope, respectively. LJ culture was used as a reference.Results. Out of 178 study participants, twenty-four (13.5%) patients were confirmed as positive for MTB with LJ culture. The yield of ZN microscopy and LED-FM in direct and concentrated sample was 3.9%, 8.4%, 6.2%, and 8.4%, respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of direct ZN microscopy were 29.2%, 100%, 100%, and 90.1%, respectively, and of LED-FM microscopy in direct sputum sample were 62.5%, 100%, 100%, and 94.5%, respectively.Conclusion. LED-FM has better sensitivity for the diagnosis of PTB in HIV positive individuals as compared to conventional ZN microscopy. LED-FM can be used as an alternative to conventional ZN microscopy.

Download Full-text

Diagnostic challenges and Gene-Xpert utility in detecting Mycobacterium tuberculosis among suspected cases of Pulmonary tuberculosis

PLoS ONE ◽

10.1371/journal.pone.0251858 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251858

Author(s):

Shaila Kabir ◽

M. Tanveer Hossain Parash ◽

Nor Amalina Emran ◽

A. B. M. Tofazzal Hossain ◽

Sadia Choudhury Shimmi

Keyword(s):

Mycobacterium Tuberculosis ◽

Pulmonary Tuberculosis ◽

Predictive Value ◽

Demographic Data ◽

Nucleic Acid Amplification ◽

Age Group ◽

Cross Sectional ◽

Care Clinic ◽

Pulmonary Tb ◽

Smear Negative

The incidence of pulmonary tuberculosis (PTB) can be reduced by preventing transmission with rapid and precise case detection and early treatment. The Gene-Xpert MTB/RIF assay is a useful tool for detecting Mycobacterium tuberculosis (MTB) with rifampicin resistance within approximately two hours by using a nucleic acid amplification technique. This study was designed to reduce the underdiagnosis of smear-negative pulmonary TB and to assess the clinical and radiological characteristics of PTB patients. This cross-sectional study included 235 participants who went to the Luyang primary health care clinic from September 2016 to June 2017. The demographic data were analyzed to investigate the association of patient gender, age group, and ethnicity by chi-square test. To assess the efficacy of the diagnostic test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The area under the curve for sputum for both AFB and gene-Xpert was analyzed to compare their accuracy in diagnosing TB. In this study, TB was more common in males than in females. The majority (50.71%) of the cases belonged to the 25–44-year-old age group and the Bajau ethnicity (57.74%). Out of 50 pulmonary TB cases (smear-positive with AFB staining), 49 samples were positive according to the Gene-Xpert MTB/RIF assay and was confirmed by MTB culture. However, out of 185 smear-negative presumptive cases, 21 cases were positive by Gene-Xpert MTB/RIF assay in that a sample showed drug resistance, and these results were confirmed by MTB culture, showing resistance to isoniazid. In comparison to sputum for AFB, Gene-Xpert showed more sensitivity and specificity with almost complete accuracy. The additional 21 PTB cases detection from the presumptive cases by GeneXpert had significant impact compared to initial observation by the routine tests which overcame the diagnostic challenges and ambiguities.

Download Full-text

Efficacy of gene xpert over other diagnostic modalities of tuberculosis among children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192752 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1545

Author(s):

Deepmala Pandey ◽

Ankur Yadav

Keyword(s):

Age Groups ◽

Sputum Smear ◽

Smear Microscopy ◽

Chi Square ◽

Diagnostic Modality ◽

Cross Sectional ◽

Exact Test ◽

Pulmonary Tb ◽

Pediatric Age Group ◽

Diagnostic Modalities

Background: Diagnosis of tuberculosis is a challenge especially among children. GeneXpert has been recommended as a diagnostic test in children. Objectives of this study was to efficacy of GeneXpert over other diagnostic modalities of Tuberculosis like Sputum smear microscopy, Mantoux testing, X-ray chest among children.Methods: A cross sectional hospital-based study was conducted over a period of 24 months among 150 children. All the patients who were having suspicion of Tuberculosis on the basis of History & Examination (fulfilling inclusion criteria) had been enrolled in the study. After doing all preliminary investigations clinical diagnosis has been made and Gene X’pert was carried out for all the samples collected. Pearson chi square test and Fishers exact test was applied wherever appropriate.Results: There was statistically no significant (p >0.05) difference of GeneXpert positivity within different age groups of Suspected TB patients. GeneXpert was positive in 80% with symptom of Cough lasting more than 2 weeks, in 78.8% with fever more than 2 weeks, in 88.9% with FTT, in 76.5% with H/O Koch’s contact, in 77.8% with H/O convulsion, in 69% with significant lymphadenopathy. GeneXpert was positive in all suspected TB patients having ZN staining positive for AFB. In clinically TB diagnosed patients, 86.5% were positive for GeneXpert.Conclusions: GeneXpert is a novel diagnostic modality of choice in all suspected Pulmonary & Extra-pulmonary TB cases among children. It can be used as a primary tool in Pulmonary TB with smear negative samples in pediatric age group.

Download Full-text

Prevalence and risk factors for SARS-CoV-2 infection in children with and without symptoms seeking care in Managua, Nicaragua: results of a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2021-051836 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051836

Author(s):

Jorge A Huete-Pérez ◽

Kacey C Ernst ◽

Cristiana Cabezas-Robelo ◽

Lucia Páiz-Medina ◽

Sheyla Silva ◽

...

Keyword(s):

Risk Factors ◽

Clinical Symptoms ◽

Age Distribution ◽

Epidemiological Data ◽

Cross Sectional Study ◽

Comorbid Condition ◽

Prevention Measures ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High Prevalence

ObjectiveThis study aimed to capture key epidemiological data on SARS-CoV-2 infection in Nicaraguan children (≤18 years) seeking medical care, between 6 October and 16 November 2020.DesignIn this cross-sectional study, 418 children were recruited: 319 with symptoms characteristic of COVID-19 and 99 with no symptoms of illness. Children were tested for SARS-CoV-2 RNA using loop-mediated isothermal amplification. A questionnaire was employed to identify symptoms, risk factors, comorbidities and COVID-19 prevention measures.SettingResearch was carried out in four hospitals and two clinics in Managua, Nicaragua, where schools and businesses remained open throughout the COVID-19 pandemic.ParticipantsChildren were enrolled into a possible COVID-19 group if presenting with clinical symptoms. A comparison group included children lacking any COVID-19 symptoms attending routine check-ups or seeking care for issues unrelated to COVID-19.ResultsA high prevalence (43%) of SARS-CoV-2 infection was found, which was relatively equivalent in symptomatic and non-symptomatic children. Age distribution was similar between symptomatic and non-symptomatic children testing positive for SARS-CoV-2. Symptomatic children who tested positive for SARS-CoV-2 were 2.7 times more likely to have diarrhoea (26.7% in positive vs 12.0% in negative; OR=2.7 (95% CI 1.5 to 4.8), p=0.001) and were 2.0 times more likely to have myalgia (17.8% in positive vs 9.8% in negative; OR=2.0 (95% CI 1.0 to 3.8), p=0.04). Children with COVID-19 symptoms, who tested positive for SARS-CoV-2, were more likely to be under age 5 years and to have a pre-existing comorbid condition than children who tested positive but did not have symptoms.ConclusionsThis is the first paediatric study to provide laboratory-confirmed data on SARS-CoV-2 infection in Nicaragua, crucial for paediatric health services planning and a successful COVID-19 response. The high prevalence of the virus suggests widespread and sustained community transmission, underscoring the urgent need for robust data on the true extent of SARS-CoV-2 infection throughout Nicaragua.

Download Full-text

Factors contributing to diagnostic delay of Caroli syndrome: a single-center, retrospective study

BMC Gastroenterology ◽

10.1186/s12876-020-01442-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Wen Shi ◽

Xiao-ming Huang ◽

Yun-lu Feng ◽

Feng-dan Wang ◽

Xiao-xing Gao ◽

...

Keyword(s):

Risk Factors ◽

Clinical Symptoms ◽

Medical Center ◽

Diagnostic Delay ◽

Mainland China ◽

Magnetic Resonance Cholangiopancreatography ◽

Laboratory Findings ◽

Hepatic Cysts ◽

Initial Symptoms ◽

Caroli Syndrome

Abstract Background Caroli syndrome (CS) is a rare congenital disorder without pathognomonic clinical symptoms or laboratory findings; therefore, the diagnosis is often delayed. The objective of this study was to investigate the diagnostic delay and associated risk factors in CS patients. Methods This was a retrospective analysis of 16 CS patients admitted to a single tertiary medical center on mainland China. The diagnostic timelines of CS patients were reviewed to demonstrate the initial findings of CS at diagnosis, the risk factors associated with diagnostic delay, and potential clues leading to early diagnosis. Results The median diagnostic delay was 1.75 years (range: 1 month to 29 years, interquartile range: 6.2 years) in 16 enrolled CS patients. Sex, age, and initial symptoms were not associated with diagnostic delay. 87.5% of CS patients were diagnosed by imaging, and the accuracies of ultrasonography, computed tomography (CT), and magnetic resonance cholangiopancreatography were 25, 69.2, and 83.3%, respectively. The median diagnostic delays for patients with or without CT performed at the first hospital visited according to physician and radiologist suspicion of the diagnosis were 7.4 months and 6 years, respectively (p = 0.021). Hepatic cysts with splenomegaly were detected by ultrasound in over half of CS patients. Conclusions The majority of CS patients were not diagnosed until complications of portal hypertension had already developed. Recognition and early suspicion of the disease were important factors influencing diagnostic delay of CS. Hepatic cysts plus splenomegaly detected by US might raise the clinical suspicion to include CS in the differential diagnosis.

Download Full-text

Contact screening and risk factors for TB among the household contact of children with active TB: a way to find source case and new TB cases

BMC Public Health ◽

10.1186/s12889-019-7597-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Madeeha Laghari ◽

Syed Azhar Syed Sulaiman ◽

Amer Hayat Khan ◽

Bandeh Ali Talpur ◽

Zohra Bhatti ◽

...

Keyword(s):

Risk Factors ◽

Clinical Symptoms ◽

Current System ◽

Significant Risk ◽

Cross Sectional Study ◽

Cross Sectional ◽

Source Of Infection ◽

Source Case ◽

Contact Screening ◽

Structured Questionnaire

Abstract Background Source case investigation, for children with tuberculosis (TB), is conducted to establish the source of infection and to minimize the extent of on-going transmission from infectious persons in the community. The aim of the study was to evaluate the secondary TB cases and to investigate the risk factors in developing TB among the household contacts (HHC) of children with active TB. Methods A prospective cross-sectional study was conducted where 443 caregivers, of 508 children with active TB receiving treatment, were interviewed using a structured questionnaire. Logistic regression analysis was used to examine the risk factors for TB. Results A total of 2397 family members at the median of 5 persons were recorded. Of these, 223 (9.3%) were screened on symptoms basis and 35 (15.7%) of these contacts were diagnosed with TB. Multivariate analysis revealed HHC with TB (OR = 15.288, 95% CI: 5.378–43.457), HHC with smoking (OR = 7.094, 95% CI: 2.128–23.648), and contact of > 18 h with TB individual (OR = 4.681, 95% CI: 1.198–18.294) as statistically significant risk factors of TB among the HHC. Conclusion With the current system of contact screening for TB, only 9.3% of all HHC were screened. The low rates of contacts screened are possibly a repercussion of the passive nature of the program, which mainly depend on distinctive clinical symptoms being experienced by the contacts. Strategies are required to certify adherence with contact screening among children with active TB and to critically consider the factors responsible for TB transmission.

Download Full-text