SETTING: University-affiliated hospital in South Africa. OBJECTIVE: To assess the time to diagnosis and the yield and laboratory cost of diagnostic procedures in human immunodeficiency virus (HIV) associated tuberculosis. DESIGN: Cohort study. PATIENTS: Adult HIV-infected patients with newly-diagnosed tuberculosis admitted over a 2-year period. RESULTS: A total of 141 admissions fulfilled the case definition. Sputum smear yield (43% overall) correlated strongly with chest radiograph appearance but not with CD4+ lymphocyte count. Sputum smear yield was approximately 40% per sample sent, resulting in a high cumulative yield when > or = three samples were sent. Smear of sputum or wide needle lymph node aspirates were the most cost-effective diagnostic methods. Significant diagnostic delay occurred in sputum smear-negative patients. Most patients with sputum smear-negative tuberculosis had either pleural effusions or lymphadenopathy. Lymph node biopsy had a high diagnostic yield even in patients with symmetrical nodes, but was under-utilised in this group. There was unnecessary expenditure on cultures, with many patients having several positive cultures. CONCLUSION: Repeated sputum smear examination produces a high cumulative yield in HIV-associated tuberculosis. Considerable savings in laboratory utilisation and bed occupancy would have been made if a streamlined diagnostic approach with greater use of lymph node aspirate and early pleural or lymph node biopsy had been followed.
SETTING: University-affiliated hospital in South Africa. OBJECTIVE: To assess the time to diagnosis and the yield and laboratory cost of diagnostic procedures in human immunodeficiency virus (HIV) associated tuberculosis. DESIGN: Cohort study. PATIENTS: Adult HIV-infectedpatients with newly-diagnosed tuberculosis admitted over a 2-year period. RESULTS: A total of 141 admissions fulfilled the case definition. Sputum smear yield (43% overall) correlated strongly with chest radiograph appearance but not with CD4+ lymphocyte count. Sputum smear yield was approximately 40% per sample sent, resulting in a high cumulative yield when > or = three samples were sent. Smear of sputum or wide needle lymph node aspirates were the most cost-effective diagnostic methods. Significant diagnostic delay occurred in sputum smear-negative patients. Most patients with sputum smear-negative tuberculosis had either pleural effusions or lymphadenopathy. Lymph node biopsy had a high diagnostic yield even in patients with symmetrical nodes, but was under-utilised in this group. There was unnecessary expenditure on cultures, with many patients having several positive cultures. CONCLUSION: Repeated sputum smear examination produces a high cumulative yield in HIV-associated tuberculosis. Considerable savings in laboratory utilisation and bed occupancy would have been made if a streamlined diagnostic approach with greater use of lymph node aspirate and early pleural or lymph node biopsy had been followed.
Authors: David W Dowdy; Richard E Chaisson; Gary Maartens; Elizabeth L Corbett; Susan E Dorman Journal: Proc Natl Acad Sci U S A Date: 2008-08-11 Impact factor: 11.205
Authors: Scott K Heysell; Anthony P Moll; Neel R Gandhi; Francois J Eksteen; Palav Babaria; Yacoob Coovadia; Lynn Roux; Umesh Lalloo; Gerald Friedland; N Sarita Shah Journal: Emerg Infect Dis Date: 2010-03 Impact factor: 6.883
Authors: David W Dowdy; Maria C Lourenço; Solange C Cavalcante; Valeria Saraceni; Bonnie King; Jonathan E Golub; David Bishai; Betina Durovni; Richard E Chaisson; Susan E Dorman Journal: PLoS One Date: 2008-12-29 Impact factor: 3.240