OBJECTIVE: To evaluate the sensitivity of acid-fast sputum smears in the diagnosis of pulmonary Mycobacterium tuberculosis (MTB). DESIGN: Retrospective chart and radiographic film review. SETTING: Department of Veterans Affairs Medical Center in New York City. PATIENTS: All patients with positive sputum cultures for MTB during 1989 to 1991, including 100 with HIV, and 76 without HIV infection. PARAMETERS: The likelihood of a positive acid-fast sputum smear, related to chest radiograph findings, CD4 cell counts, drug sensitivity, and the presence of disseminated disease. RESULTS: Overall, 60 percent of patients with HIV had positive acid-fast smears, compared with 57 percent of non-HIV-infected patients. A relative absence of cavitary infiltrates did not substantially reduce the frequency of acid-fast smears in patients with and without HIV. Patients with HIV and CD4 count < 50, 50 to 200, and > 200 had positive acid-fast smear rates of 58 percent, 60 percent, and 56 percent, respectively; HIV-infected patients with drug-resistant organisms had 65 percent positive smears. Smear positivity was 96 percent in patients with HIV infection and disseminated MTB, CONCLUSIONS: Positive acid-fast sputum smears in culture-proven MTB occur with similar frequency in patients with and without HIV. The absence of cavitary disease did not significantly reduce the frequency of positive acid-fast smears. For patients with HIV, the likelihood of a positive smear was also independent of CD4 cell counts and drug resistance. Patients with HIV and disseminated MTB had positive sputum smears in nearly all cases.
OBJECTIVE: To evaluate the sensitivity of acid-fast sputum smears in the diagnosis of pulmonary Mycobacterium tuberculosis (MTB). DESIGN: Retrospective chart and radiographic film review. SETTING: Department of Veterans Affairs Medical Center in New York City. PATIENTS: All patients with positive sputum cultures for MTB during 1989 to 1991, including 100 with HIV, and 76 without HIV infection. PARAMETERS: The likelihood of a positive acid-fast sputum smear, related to chest radiograph findings, CD4 cell counts, drug sensitivity, and the presence of disseminated disease. RESULTS: Overall, 60 percent of patients with HIV had positive acid-fast smears, compared with 57 percent of non-HIV-infectedpatients. A relative absence of cavitary infiltrates did not substantially reduce the frequency of acid-fast smears in patients with and without HIV. Patients with HIV and CD4 count < 50, 50 to 200, and > 200 had positive acid-fast smear rates of 58 percent, 60 percent, and 56 percent, respectively; HIV-infectedpatients with drug-resistant organisms had 65 percent positive smears. Smear positivity was 96 percent in patients with HIV infection and disseminated MTB, CONCLUSIONS: Positive acid-fast sputum smears in culture-proven MTB occur with similar frequency in patients with and without HIV. The absence of cavitary disease did not significantly reduce the frequency of positive acid-fast smears. For patients with HIV, the likelihood of a positive smear was also independent of CD4 cell counts and drug resistance. Patients with HIV and disseminated MTB had positive sputum smears in nearly all cases.
Authors: H J Menzies; G Moalosi; V Anisimova; V Gammino; C Sentle; M A Bachhuber; E Bile; K Radisowa; O Kachuwaire; J Basotli; T Maribe; R Makombe; J Shepherd; B Kim; T Samandari; S El-Halabi; J Chirenda; K P Cain Journal: Int J Tuberc Lung Dis Date: 2014-09 Impact factor: 2.373
Authors: Thuy T Trinh; Dien T Han; Emily Bloss; Thai H Le; Tung T Vu; Anh H Mai; Nhung V Nguyen; Long T Nguyen; Sy N Dinh; Sara Whitehead Journal: Trans R Soc Trop Med Hyg Date: 2015-10 Impact factor: 2.184