The utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence setting.

Autor: Barnard DA; Divisions of Pulmonology, Department of Medicine, Stellenbosch University, PO Box 19063, 7505, Cape Town, South Africa. dabarnard@live.com.; Tygerberg Academic Hospital, Cape Town, South Africa. dabarnard@live.com., Irusen EM; Divisions of Pulmonology, Department of Medicine, Stellenbosch University, PO Box 19063, 7505, Cape Town, South Africa. eirusen@sun.ac.za.; Tygerberg Academic Hospital, Cape Town, South Africa. eirusen@sun.ac.za., Bruwer JW; Divisions of Pulmonology, Department of Medicine, Stellenbosch University, PO Box 19063, 7505, Cape Town, South Africa. cdchar@sun.ac.za.; Tygerberg Academic Hospital, Cape Town, South Africa. cdchar@sun.ac.za., Plekker D; Kuils River Hospital, Cape Town, South Africa. dp.krrc@mwebbiz.co.za., Whitelaw AC; Tygerberg Academic Hospital, Cape Town, South Africa. awhitelaw@sun.ac.za.; Division of Medical Microbiology and Immunology, Department of Pathology, Stellenbosch University, Cape Town, South Africa. awhitelaw@sun.ac.za.; National Health Laboratory Services, Cape Town, South Africa. awhitelaw@sun.ac.za., Deetlefs JD; Ampath Laboratories, Cape Town, South Africa. deetlefsj@ampath.co.za., Koegelenberg CF; Divisions of Pulmonology, Department of Medicine, Stellenbosch University, PO Box 19063, 7505, Cape Town, South Africa. coeniefn@sun.ac.za.; Tygerberg Academic Hospital, Cape Town, South Africa. coeniefn@sun.ac.za.
Jazyk: angličtina
Zdroj: BMC pulmonary medicine [BMC Pulm Med] 2015 Sep 16; Vol. 15, pp. 103. Date of Electronic Publication: 2015 Sep 16.
DOI: 10.1186/s12890-015-0086-z
Abstrakt: Background: Xpert MTB/RIF has been shown to have a superior sensitivity to microscopy for acid fast bacilli (AFB) in sputum and has been recommended as a standard first line investigation for pulmonary tuberculosis (PTB). Bronchoscopy is a valuable tool in diagnosing PTB in sputum negative patients. There is limited data on the utility of Xpert MTB/RIF performed on bronchial lavage specimens. Our aim was to evaluate the diagnostic efficiency of Xpert MTB/RIF performed on bronchial washings in sputum scarce/negative patients with suspected PTB.
Methods: All patients with a clinical and radiological suspicion of PTB who underwent bronchoscopy between January 2013 and April 2014 were included. The diagnostic efficiencies of Xpert MTB/RIF and microscopy for AFB were compared to culture for Mycobacterium tuberculosis.
Results: Thirty nine of 112 patients were diagnosed with culture-positive PTB. Xpert MTB/RIF was positive in 36/39 with a sensitivity of 92.3% (95% CI 78-98%) for PTB, which was superior to that of smear microscopy (41%; 95% CI 26.0-57.8%, p = 0.005). The specificities of Xpert MTB/RIF and smear microscopy were 87.7% (95% CI 77.4-93.9%) and 98.6% (95% CI 91.6%-99.9%) respectively. Xpert MTB/RIF had a positive predictive value of 80% (95% CI; 65-89.9%) and negative predictive value of 95.5% (95% CI 86.6-98.8%). 3/9 patients with Xpert MTB/RIF positive culture negative results were treated for PTB based on clinical and radiological findings.
Conclusion: Xpert MTB/RIF has a higher sensitivity than smear microscopy and similar specificity for the immediate confirmation of PTB in specimens obtained by bronchial washing, and should be utilised in patients with a high suspicion of pulmonary tuberculosis.
Databáze: MEDLINE
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