OBJECTIVE: To evaluate commonly available screening tests for pulmonary tuberculosis (TB), using sputum bacteriology as a gold standard, in HIV-infected persons attending an urban voluntary counseling and testing clinic in Addis Ababa, Ethiopia. DESIGN: Prospective enrollment of HIV-infected persons, all of whom underwent TB screening, regardless of symptoms, with: (1) symptom screening and physical examination, (2) 3 sputum specimens for smear microscopy, and (3) chest radiograph. One sputum was also sent for concentrated smear microscopy and mycobacterial culture. Chest radiographs were reviewed by 2 independent radiologists. A confirmed TB diagnosis was defined as 1 positive sputum smear and/or 1 positive sputum culture. RESULTS: We enrolled 438 HIV-infected persons: 265 (61%) females, median age 34 years (range: 18-65), median CD4 cell count 181 cells per cubic millimeter (range: 2-1185). Overall, 32 (7%) persons were diagnosed with TB, of whom 5 (16%) were asymptomatic but culture-confirmed TB cases. Screening for cough >2 weeks would have detected only 12 (38%) confirmed TB cases; screening for cough or fever, of any duration, would have detected 24 (75%) cases, with specificity of 64%. Negative predictive value of screening for these 2 symptoms was 97%. Simulation of the current Ethiopian national guidelines had a sensitivity of 63% and specificity of 83% for diagnosing TB disease among study patients. CONCLUSIONS: Traditional symptom screening is insufficient for detecting TB disease among HIV-infected persons but may serve to exclude TB disease. More sensitive, rapid, and low-cost diagnostic tests are needed to meet the demand of resource-limited settings.
OBJECTIVE: To evaluate commonly available screening tests for pulmonary tuberculosis (TB), using sputum bacteriology as a gold standard, in HIV-infectedpersons attending an urban voluntary counseling and testing clinic in Addis Ababa, Ethiopia. DESIGN: Prospective enrollment of HIV-infectedpersons, all of whom underwent TB screening, regardless of symptoms, with: (1) symptom screening and physical examination, (2) 3 sputum specimens for smear microscopy, and (3) chest radiograph. One sputum was also sent for concentrated smear microscopy and mycobacterial culture. Chest radiographs were reviewed by 2 independent radiologists. A confirmed TB diagnosis was defined as 1 positive sputum smear and/or 1 positive sputum culture. RESULTS: We enrolled 438 HIV-infectedpersons: 265 (61%) females, median age 34 years (range: 18-65), median CD4 cell count 181 cells per cubic millimeter (range: 2-1185). Overall, 32 (7%) persons were diagnosed with TB, of whom 5 (16%) were asymptomatic but culture-confirmed TB cases. Screening for cough >2 weeks would have detected only 12 (38%) confirmed TB cases; screening for cough or fever, of any duration, would have detected 24 (75%) cases, with specificity of 64%. Negative predictive value of screening for these 2 symptoms was 97%. Simulation of the current Ethiopian national guidelines had a sensitivity of 63% and specificity of 83% for diagnosing TB disease among study patients. CONCLUSIONS: Traditional symptom screening is insufficient for detecting TB disease among HIV-infectedpersons but may serve to exclude TB disease. More sensitive, rapid, and low-cost diagnostic tests are needed to meet the demand of resource-limited settings.
Authors: A Steiner; C Mangu; J van den Hombergh; H van Deutekom; B van Ginneken; P Clowes; F Mhimbira; S Mfinanga; A Rachow; K Reither; M Hoelscher Journal: Public Health Action Date: 2015-12-21
Authors: S Zaeh; R Kempker; E Stenehjem; H M Blumberg; O Temesgen; I Ofotokun; A Tenna Journal: Int J Tuberc Lung Dis Date: 2013-11 Impact factor: 2.373
Authors: Martha Alemayehu; Baye Gelaw; Ebba Abate; Liya Wassie; Yeshambel Belyhun; Shiferaw Bekele; Russell R Kempker; Henry M Blumberg; Abraham Aseffa Journal: Int J Mycobacteriol Date: 2014-03-24
Authors: J Lucian Davis; William Worodria; Harriet Kisembo; John Z Metcalfe; Adithya Cattamanchi; Michael Kawooya; Rachel Kyeyune; Saskia den Boon; Krista Powell; Richard Okello; Samuel Yoo; Laurence Huang Journal: PLoS One Date: 2010-03-26 Impact factor: 3.240