RATIONALE: Serial smear analysis to guide respiratory isolation (RI) of patients with suspected tuberculosis (TB), the majority of whom will be found not to have TB, leads to expensive and unnecessary isolation, and may potentially result in decreased vigilance of subjects with respiratory compromise. OBJECTIVES: To compare the performance of a single first-sputum, Mycobacterium tuberculosis-specific nucleic acid amplification (NAA) test with three sputum smears for assessing the need for RI. METHODS: Prospective evaluation of 493 patients with suspected TB (74% HIV positive) admitted to RI in a major county hospital in the United States, who had at least three sputum smears and material available from the first sample for additional NAA testing. MEASUREMENTS AND MAIN RESULTS: Accuracy of the first sputum NAA result and serial smears for identifying patients with potentially infectious TB who truly require RI was determined. Forty-six patients (9.3%) had TB confirmed by culture. First-sputum NAA test detected all patients with TB who had a positive smear (n = 35), even when the first of the three specimens was smear negative. In addition, when compared with serial smears, the first-sputum NAA had a higher sensitivity (0.87; 95% confidence interval [CI], 0.74-0.95) and specificity (1.0) in the detection of subjects with positive M. tuberculosis cultures (smear sensitivity, 0.76; 95% CI, 0.61-0.87; and specificity, 0.96; 95% CI, 0.94-0.98). CONCLUSIONS: A single first-sputum NAA testing can rapidly and accurately identify the subset of patients with suspected TB who require RI according to serial sputum smears. Its potential use to shorten RI time does not preclude the need to obtain subsequent specimens for culture.
RATIONALE: Serial smear analysis to guide respiratory isolation (RI) of patients with suspected tuberculosis (TB), the majority of whom will be found not to have TB, leads to expensive and unnecessary isolation, and may potentially result in decreased vigilance of subjects with respiratory compromise. OBJECTIVES: To compare the performance of a single first-sputum, Mycobacterium tuberculosis-specific nucleic acid amplification (NAA) test with three sputum smears for assessing the need for RI. METHODS: Prospective evaluation of 493 patients with suspected TB (74% HIV positive) admitted to RI in a major county hospital in the United States, who had at least three sputum smears and material available from the first sample for additional NAA testing. MEASUREMENTS AND MAIN RESULTS: Accuracy of the first sputum NAA result and serial smears for identifying patients with potentially infectious TB who truly require RI was determined. Forty-six patients (9.3%) had TB confirmed by culture. First-sputum NAA test detected all patients with TB who had a positive smear (n = 35), even when the first of the three specimens was smear negative. In addition, when compared with serial smears, the first-sputum NAA had a higher sensitivity (0.87; 95% confidence interval [CI], 0.74-0.95) and specificity (1.0) in the detection of subjects with positive M. tuberculosis cultures (smear sensitivity, 0.76; 95% CI, 0.61-0.87; and specificity, 0.96; 95% CI, 0.94-0.98). CONCLUSIONS: A single first-sputum NAA testing can rapidly and accurately identify the subset of patients with suspected TB who require RI according to serial sputum smears. Its potential use to shorten RI time does not preclude the need to obtain subsequent specimens for culture.
Authors: Lelia H Chaisson; David Duong; Adithya Cattamanchi; Marguerite Roemer; Margaret A Handley; Dean Schillinger; Matthew Sur; Phong Pham; Mary Ann Lin; L Elizabeth Goldman; Judy Quan; Saida Perez; Michael Healy; Julie Higashi; Lisa Winston; Barbara Haller; Anne F Luetkemeyer; J Lucian Davis Journal: JAMA Intern Med Date: 2018-10-01 Impact factor: 21.873
Authors: Danica Helb; Martin Jones; Elizabeth Story; Catharina Boehme; Ellen Wallace; Ken Ho; JoAnn Kop; Michelle R Owens; Richard Rodgers; Padmapriya Banada; Hassan Safi; Robert Blakemore; N T Ngoc Lan; Edward C Jones-López; Michael Levi; Michele Burday; Irene Ayakaka; Roy D Mugerwa; Bill McMillan; Emily Winn-Deen; Lee Christel; Peter Dailey; Mark D Perkins; David H Persing; David Alland Journal: J Clin Microbiol Date: 2009-10-28 Impact factor: 5.948
Authors: Susmita Sarkar; Xinli L Tang; Dipankar Das; John S Spencer; Todd L Lowary; Mavanur R Suresh Journal: PLoS One Date: 2012-02-21 Impact factor: 3.240
Authors: Yingda L Xie; Wendy A Cronin; Michael Proschan; Richard Oatis; Silvia Cohn; Scott R Curry; Jonathan E Golub; Clifton E Barry; Susan E Dorman Journal: Clin Infect Dis Date: 2018-11-13 Impact factor: 20.999