scholarly journals DETECTION FAILURE OF SMEAR MICROSCOPY TO CONFIRM PULMONARY TUBERCULOSIS

2018 ◽  
Vol 6 (4) ◽  
Author(s):  
Yunusa EU ◽  
Bakare AT ◽  
Shagari GB ◽  
Abubakar AM ◽  
Sharhabila Y ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Positive Culture ◽  
Culture Method ◽  
Molecular Diagnostic ◽  
Smear Microscopy ◽  
Reference Laboratory ◽  
Sample Collection ◽  
Cross Sectional ◽  
Detection Failure ◽  
Culture Positive

Background: The laboratories in poor resource settings commonly use smear microscopy for the diagnosis of pulmonary tuberculosis, because it is rapid, inexpensive and easy to perform. The commonly use Lowensten Jensen culture method for the diagnosis of tuberculosis is slow and usually not very sensitive. Polymerase Chain Reaction (PCR) in the diagnosis of tuberculosis (TB) has come to stay as an effective diagnostic tool for effective pulmonary TB case detections. Objectives: This is to promote and encourage utilization of molecular diagnostic method (PCR) for the diagnosis of tuberculosis especially in smear negative microscopy suspected cases to reduce the rate of missed diagnosis. Material and Methods: This was an observational cross sectional prospective study among patients who presented at tuberculosis reference laboratory with request form for the diagnosis of pulmonary tuberculosis. Consent forms were administered and only consented clients were enrolled in the study. Standard sample collection criteria were used for all collected samples subjected to standard smear microscopy, Lowenstein Jensen culture and PCR studies. Results: Direct smear microscopy (AFB) was positive in 13 (13.5%), 24 (23.3%) were detected by PCR and 20 (19.4%) were culture positive. All positive smears were found to be positive for both culture and PCR. All culture positive samples were positive by PCR, culture growth were also positive by PCR. Most of the PCR results were ready within the first day of the analysis with average of 1.2 days (P = 0.014) of the 103 samples processed. The result of smear microscopy is only ready on the second day after analysis of the second and third samples submitted with reported average of 1.7 days (P = 0.035). The fastest observable growth of positive culture was seen only within ten days and only three cases showed such. It took eight weeks for a negative growth to be regarded as negative. The culture has an average tun around ti

scholarly journals DETECTION FAILURE OF SMEAR MICROSCOPY TO CONFIRM PULMONARY TUBERCULOSIS

2018 ◽  
Vol 6 (4) ◽  
Author(s):  
Yunusa EU ◽  
Bakare AT ◽  
Shagari GB ◽  
Abubakar AM ◽  
Sharhabila Y ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Positive Culture ◽  
Culture Method ◽  
Molecular Diagnostic ◽  
Smear Microscopy ◽  
Reference Laboratory ◽  
Sample Collection ◽  
Cross Sectional ◽  
Detection Failure ◽  
Culture Positive

Background: The laboratories in poor resource settings commonly use smear microscopy for the diagnosis of pulmonary tuberculosis, because it is rapid, inexpensive and easy to perform. The commonly use Lowensten Jensen culture method for the diagnosis of tuberculosis is slow and usually not very sensitive. Polymerase Chain Reaction (PCR) in the diagnosis of tuberculosis (TB) has come to stay as an effective diagnostic tool for effective pulmonary TB case detections. Objectives: This is to promote and encourage utilization of molecular diagnostic method (PCR) for the diagnosis of tuberculosis especially in smear negative microscopy suspected cases to reduce the rate of missed diagnosis. Material and Methods: This was an observational cross sectional prospective study among patients who presented at tuberculosis reference laboratory with request form for the diagnosis of pulmonary tuberculosis. Consent forms were administered and only consented clients were enrolled in the study. Standard sample collection criteria were used for all collected samples subjected to standard smear microscopy, Lowenstein Jensen culture and PCR studies. Results: Direct smear microscopy (AFB) was positive in 13 (13.5%), 24 (23.3%) were detected by PCR and 20 (19.4%) were culture positive. All positive smears were found to be positive for both culture and PCR. All culture positive samples were positive by PCR, culture growth were also positive by PCR. Most of the PCR results were ready within the first day of the analysis with average of 1.2 days (P = 0.014) of the 103 samples processed. The result of smear microscopy is only ready on the second day after analysis of the second and third samples submitted with reported average of 1.7 days (P = 0.035). The fastest observable growth of positive culture was seen only within ten days and only three cases showed such. It took eight weeks for a negative growth to be regarded as negative. The culture has an average tun around ti

scholarly journals Prevalence of pulmonary tuberculosis among patients presenting with cough of any duration in Addis Ababa, Ethiopia

2019 ◽  
Author(s):  
Aynye Negesse ◽  
Mulugeta Belay ◽  
Girmay Medhin ◽  
Sosina Ayalew ◽  
Adane Mihret ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Addis Ababa ◽  
Culture Method ◽  
Cross Sectional Study ◽  
Smear Microscopy ◽  
Culture Methods ◽  
Cross Sectional ◽  
Study Participants ◽  
Age Range ◽  
Culture Positive

AbstractBackgroundThe current practice in Ethiopia to diagnose tuberculosis is screening patients with cough for at least two weeks. A health facility based study was conducted to estimate the prevalence of smear and culture positive pulmonary TB among patients presenting with cough ≥2 weeks and <2 weeks in Addis Ababa, Ethiopia.MethodsA cross-sectional study design was used to recruit patients with cough of any duration from four selected health centers in Addis Ababa, between August and December 2016. Sputum samples were collected from patients reporting productive cough of any duration and screened for Pulmonary Tuberculosis (PTB) using smear microscopy and culture methods. Mycobacterium tuberculosis isolates obtained from culture positive samples were characterized using RD9 deletion typing.ResultsMajority (39.7%) of the 725 study participants was in the age range of 20-30 years, and 5.0% were smear positive using smear microscopy. The prevalence of smear positive PTB among patients presented with cough duration of ≥2 weeks was significantly higher compared to those patients presented with cough duration of <2 weeks (10.9% versus 0.7%; χ2=38.98; p=0.001). Using culture method, a total of 86 (11.9%) participants were positive for mycobacteria, and the prevalence (14.6%) of PTB among patients presented with cough duration of ≥2 weeks was not significantly higher compared to prevalence (9.9%) in those patients presented with cough duration of <2 weeks (χ2=3.63; p=0.057). Molecular characterization of 86 culture positive mycobacterial isolates showed that 41 were infected with Mtb; 19(46.3%) from those who had cough duration of <2 weeks and 22(53.7%) from those who had cough duration of ≥2 weeks.ConclusionScreening of PTB using smear microscopy alone and cough duration of at least two weeks would negatively affect early diagnosis and treatment initiation in a considerable number of PTB patients who reports cough duration of <2 weeks with the potential of contributing to the spread of TB. Therefore, screening of patients with cough of any duration using both smear microscopy and culture methods is likely to contribute to the success of any effort towards the control of TB.

scholarly journals Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Eastern Sudan

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Yassir A. Shuaib ◽  
Eltahir A. G. Khalil ◽  
Ulrich E. Schaible ◽  
Lothar H. Wieler ◽  
Mohammed A. M. Bakheit ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Reference Laboratory ◽  
Middle Income ◽  
Culture Positive ◽  
Eastern Sudan

Background. In Sudan, tuberculosis diagnosis largely relies on clinical symptoms and smear microscopy as in many other low- and middle-income countries. The aim of this study was to investigate the positive predictive value of a positive sputum smear in patients investigated for pulmonary tuberculosis in Eastern Sudan. Methods. Two sputum samples from patients presenting with symptoms suggestive of tuberculosis were investigated using direct Ziehl-Neelsen (ZN) staining and light microscopy between June to October 2014 and January to July 2016. If one of the samples was smear positive, both samples were pooled, stored at −20°C, and sent to the National Reference Laboratory (NRL), Germany. Following decontamination, samples underwent repeat microscopy and culture. Culture negative/contaminated samples were investigated using polymerase chain reaction (PCR). Results. A total of 383 samples were investigated. Repeat microscopy categorized 123 (32.1%) as negative, among which 31 were culture positive. This increased to 80 when PCR and culture results were considered together. A total of 196 samples were culture positive, of which 171 (87.3%), 14 (7.1%), and 11 (5.6%) were M. tuberculosis, M. intracellulare, and mixed species. Overall, 15.6% (57/365) of the samples had no evidence of M. tuberculosis, resulting in a positive predictive value of 84.4%. Conclusions. There was a discordance between the results of smear microscopy performed at local laboratories in the Sudan and at the NRL, Germany; besides, a considerable number of samples had no evidence of M. tuberculosis. Improved quality control for smear microscopy and more specific diagnostics are crucial to avoid possible overtreatment.

scholarly journals Prevalence of Antibiotic Resistance to Isonicotinylhydrazide and Rifampicin in Culture Positive Pulmonary Tuberculosis Patients From 2014 to 2016 in Zahedan City, Iran

2019 ◽  
Vol 4 (2) ◽  
pp. 57-61
Author(s):  
Seyed Mohammad Hashemi Shahri ◽  
Fatemeh Fardoust ◽  
Shokoufeh Mogharabi Ostad Kalayeh ◽  
Mohammad Ghenaatpisheh Sanani
Keyword(s):  
Antibiotic Resistance ◽  
Pulmonary Tuberculosis ◽  
Positive Culture ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
Pulmonary Tb ◽  
The World ◽  
Culture Positive

Background: One third of the world’s population is infected with TB, and the disease is known as the second deadly global infection, even more severe than measles. The disease kills about 2 million people a year. Approximately 8 million people in the world are affected by advanced tuberculosis (TB). Objective: The current study aimed to determine the frequency of resistance to the antibiotics isoniazid and rifampin in positive culture pulmonary TB patients in Zahedan city during 2013-2016. Methods: This descriptive cross-sectional study studied 100 samples from patients who referred to Boo-Ali hospital of Zahedan city from 2014 to 2016. First, the isoniazid solution was prepared, and then the rifampin solution was prepared. After that, 200 μL of mycobacterium suspension was added to the antibiotic and antibiotic-free control. Results: Of 100 patients participating in the study, 50 (50%) were male and 50 (50%) were female. Participants had an average age of 51.69 ± 20.41 years (95-12 years), 79 (79%) were Iranians and 21 (21%) were Afghans. Of the 100 samples, 55 (55%) were from the year 2013, 21 (21%) were from 2014, 10 (10%) were from 2015, and 14 (14%) were from year 2016. The samples examined showed that 4 (4%) were resistant and 96% were sensitive. Conclusion: The results of the current study showed that out of 100 samples, 4 cases (4%) had resistance and 96% were sensitive; 2% were resistant to isoniazid, and 2% were resistant to isoniazid and rifampin.

scholarly journals Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037913
Author(s):  
Mala George ◽  
Geert-Jan Dinant ◽  
Efrem Kentiba ◽  
Teklu Teshome ◽  
Abinet Teshome ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Cross Sectional Study ◽  
Clinical Suspicion ◽  
Secondary Outcome ◽  
Northern Ethiopia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Smear Negative ◽  
Culture Positive ◽  
Culture Negative

ObjectivesTo evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.DesignA cross-sectional study.SettingTwo public referral hospitals in Tigray, Ethiopia.ParticipantsA total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.Primary and secondary outcome measuresA total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.ResultsThe strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.ConclusionsOur finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

scholarly journals Tuberculosis Status and Coinfection of Pulmonary Fungal Infections in Patients Referred to Reference Laboratory of Health Centers Ghaemshahr City during 2007-2017

1970 ◽  
Vol 28 (6) ◽  
Author(s):  
Mohammad Reza Jabbari Amiri ◽  
Rora Siami ◽  
Azad Khaledi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Fungal Infections ◽  
Cross Sectional Study ◽  
Health Centers ◽  
Sputum Smear ◽  
P Value ◽  
Reference Laboratory ◽  
Cross Sectional ◽  
Pulmonary Fungal Infections ◽  
Student’S T

BACKGROUND: Pulmonary tuberculosis is one of the most important health concerns. Pulmonary fungal infections have clinical and radiological characteristics similar to tuberculosis which may be easily misdiagnosed as tuberculosis. This study aimed to evaluate tuberculosis (TB) status and coinfection of TB with pulmonary fungal infections in patients referred to reference laboratory of health centers Ghaemshahr city during 2007-2017.METHODS: This cross-sectional study was conducted during eleven years, between 2007 2017, on 3577 patients with suspected TB referred to health centers of Ghaemshahr City. For isolation, sputum smear preparation and Ziehl-Neelson staining in companying with microscopy direct observation and KOH 10% + white Calcofluor staining was used. The culture of fungi was performed on Sabouraud Dextrose agar, Czapek and chrome agar media. Then, data were analyzed using SPSS software (version 16) through Student's t-test, Fisher test, and Odds Ratio. P values <0.05 were considered statistically significant.RESULTS: Of 3577 patients, 10731 smears were prepared, 3.6% (n=130) of patients were identified as smear-positive pulmonary tuberculosis, 86.4% (n=3090) were smear negative and 10% (n=357) drug-resistant TB. The mean age of patients was 48±1.8 years. With increasing age, the prevalence of TB has increased which was statistically significant (P value <0.05). Prevalence of tuberculosis in the age group over than 57 years in males and females had an ascending trend. Amongst the positive tuberculosis patients, 16/130 cases (12.3%) had the coinfection of TB with fungi microorganisms.CONCLUSION: Our findings showed the coinfection of fungi agents in patients with tuberculosis that should be considered. 

scholarly journals Diagnosis of tuberculosis from smear-negative presumptive TB cases using Xpert MTB/Rif assay: a cross-sectional study from Nepal

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Priyatam Khadka ◽  
Januka Thapaliya ◽  
Ramesh Bahadur Basnet ◽  
Gokarna Raj Ghimire ◽  
Jyoti Amatya ◽  
...  
Keyword(s):  
Previous History ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Molecular Diagnostic ◽  
Smear Microscopy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Smear Negative ◽  
Negative Sputum

Abstract Background In most developing countries, smear-negative pulmonary TB (SNPT) often gets missed from the diagnosis of consideration, though it accounts 30–65% of total PTB cases, due to deficient or inaccessible molecular diagnostic modalities. Methods The cross-sectional study enrolled 360 patients with clinical-radiological suspicion of SNPT in Tribhuvan University Teaching Hospital (TUTH). The patient selection was done as per the algorithm of Nepal’s National Tuberculosis Program (NTP) for Xpert MTB/RIF testing. Participants’ demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer’s protocol. The same samples were stained using the Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with a Line Probe Assay. Result Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3(0.8%) of them were rifampicin resistance. The infection was higher in males, i.e. 60(25.3%) compared to female 25(20.3%). The age group, > 45(nearly 33%) with median age 42 ± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH. Consequently, with Xpert MTB/RIF assay, the additional case 16.5% (n = 85/515) from smear-negative presumptive TB cases were detected. Among the most occurring clinical presentations, cough and chest pain were positively associated with SNPT. While upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were the most peculiar radiological impression noted in PTB patient. 94 multi-drug resistant(MDR) suspected cases were enrolled; of total suspects, 29(30.8%) samples were rifampicin sensitive, 1(1.06%) indeterminate, 3(3.19%) rifampicin-resistant while remaining of them were negative. 2(2.2%) MDR cases were recovered from the patient with a previous history of ATT, of total 89 previously treated cases enrolled However, a single rifampicin-resistant from the new suspects. Conclusion With an application of the assay, the additional cases, missed with smear microscopy, could be sought and exact incidence of the diseases could be revealed.

scholarly journals Comparison of Led Fluorescent Microscopy and the Gene Xpert MTB/RIF Assay in Diagnosis of Pulmonary and Extrapulmonary Tuberculosis

2019 ◽  
Vol 6 ◽  
pp. 127-132
Author(s):  
Sanam Thapa Magar ◽  
Gokarna Ghimire ◽  
Pradeep Kumar Shah
Keyword(s):  
Pulmonary Tuberculosis ◽  
Extrapulmonary Tuberculosis ◽  
Fluorescent Microscopy ◽  
Cross Sectional Study ◽  
Smear Microscopy ◽  
Cross Sectional ◽  
Female Ratio ◽  
Standard Guideline ◽  
National Tuberculosis ◽  
Male To Female

Objectives: The objective of this study was to evaluate Gene Xpert MTB/RIF Assay and anid fast staining (AFB) for rapid detection of Mycobacterium tuberculosis in specimen of patients suspected of pulmonary tuberculosis (PTB) and extra pulmonary tuberculosis (EPTB). Methods: A comparative cross-sectional study of 400 samples (PTB-365 and EPTB-35) of patients visiting National Tuberculosis Centre (NTC) was conducted from July 2018 to December 2018. Gene Xpert MTB/ RIF Assay, smear microscopy were performed under standard guideline inside biosafety cabinet class II. The result obtained from both the tests were analyzed using SPSS 20.0 software and Excel 2019. Results: Of the total samples, 18% (72/400) and 39% (156/400) were positive by AFB smear microscopy and Xpert MTB/RIF assay respectively. Prevalence of MTB positive was highest in the age group 35-44 years, 33 cases (17.74%) were detected in total, with a male to female ratio of 2.3:1. Pleural fluid, pus, and CSF fluid also yielded positive results with the Gene Xpert MTB/RIF assay accounting 1.28%, 0.64% and 1.28% of MTB positive case respectively. Rifampicin resistance was observed in 1.28% of the cases. Conclusion: The key findings of this study suggest that Gene Xpert test should be implemented as primary diagnostic test for PTB and EPTB.

scholarly journals Evaluation of Gene Xpert Mtb/Rif Assay for the Detection of Mycobacterium Tuberculosis in Sputum of Patients Suspected of Pulmonary Tuberculosis Visiting National Tuberculosis Centre, Thimi, Bhaktapur, Nepal

2017 ◽  
Vol 13 (1) ◽  
pp. 16-22
Author(s):  
Ashok Thapa ◽  
P Gurung ◽  
G R Ghimire
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Predictive Value ◽  
Sputum Sample ◽  
Culture Method ◽  
Smear Microscopy ◽  
National Tuberculosis ◽  
Standard Culture ◽  
Sensitivity Specificity ◽  
And Control

Introduction: Tuberculosis (TB) is one of the most deadly and common major infectious diseases in developing countries. Rapid and accurate diagnosis of tuberculosis is indispensable to adequately manage the disease and control its transmission. The objective of this study was to evaluate Gene Xpert MTB/RIF Assay for detection of M. tuberculosis in sputum of patients suspected of pulmonary tuberculosis and its comparison with traditional conventional methods.Methodology: A total of 138 patients sputum samples were collected and processed. Gene Xpert MTB/ RIF Assay, culture method and smear microscopy were performed under standard guideline inside biosafety cabinet class II. Data were reported, structured and analyzed using SPSS version 16.00. Study was carried out from June to November 2014.Results: Assay detected M. tuberculosis in 37 (26.81%) samples out of total 138. Of these 37, 10 and 3 were resistance and indeterminate to rifampicin respectively. Culture, Ziehl-Neelsen staining and Auramine staining were positive in 43 (31.16%), 18 (13.04%) and 24 (17.39%) samples respectively. Sensitivity, specificity, Positive predictive value and Negative predictive value of Assay were 76.74%, 95.79%, 89.19% and 90.09% respectively with reference to gold standard culture method.Conclusions: Assay was found rapid in direct detec tion of Mycobacterium tuberculosis in sputum sample and was also found more sensitive than both Ziehl-Neelsen staining and Auramine staining and especially showed good promise in diagnosis of smear negative specimens.SAARC J TUBER LUNG DIS HIV/AIDS, 2016; XIII(1), page: 16-22

scholarly journals Diagnostic Accuracy of the Small Membrane Filtration Method for Diagnosis of Pulmonary Tuberculosis in a High-HIV-Prevalence Setting

2016 ◽  
Vol 54 (6) ◽  
pp. 1520-1527 ◽  
Author(s):  
Yap Boum ◽  
Soyeon Kim ◽  
Patrick Orikiriza ◽  
Carlos Acuña-Villaorduña ◽  
Solange Vinhas ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Diagnostic Accuracy ◽  
Membrane Filtration ◽  
Culture Media ◽  
Clinical History ◽  
Smear Microscopy ◽  
Filtration Method ◽  
Mgit Culture ◽  
Southwestern Uganda ◽  
Culture Positive

Sputum acid-fast bacilli (AFB) smear microscopy has suboptimal sensitivity but remains the most commonly used laboratory test to diagnose pulmonary tuberculosis (TB). We prospectively evaluated the small membrane filtration (SMF) method that concentrates AFB in a smaller area to facilitate detection to improve the diagnostic performance of microscopy. We enrolled adults with suspicion of pulmonary TB from health facilities in southwestern Uganda. Clinical history, physical examination, and 3 sputum samples were obtained for direct fluorescent AFB smear, SMF, Xpert MTB/RIF, and MGIT culture media. Sensitivity and specificity were estimated for SMF, AFB smear, and Xpert MTB/RIF, using MGIT as the reference standard. The analysis was stratified according to HIV status. From September 2012 to April 2014, 737 participants were included in the HIV-infected stratum (146 [20.5%] were culture positive) and 313 were in the HIV-uninfected stratum (85 [28%] were culture positive). In HIV-infected patients, the sensitivity of a single SMF was 67.4% (95% confidence interval [CI], 59.9% to 74.1%); for AFB, 68.0% (95% CI, 60.6% to 74.6%); and for Xpert MTB/RIF, 91.0% (95% CI, 85.0% to 94.8%). In HIV-uninfected patients, the corresponding sensitivities were 72.5% (95% CI, 62.1% to 80.9%), 80.3% (95% CI, 70.8% to 87.2%), and 93.5% (95% CI, 85.7% to 97.2%). The specificity for all 3 tests in both HIV groups was ≥96%. In this setting, the SMF method did not improve the diagnostic accuracy of sputum AFB. The Xpert MTB/RIF assay performed well in both HIV-infected and -uninfected groups.

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