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Please use this identifier to cite or link to this item:
http://hdl.handle.net/123456789/646
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| Title: | Sensitivity of direct versus concentrated sputum smear microscopy in HIV-infected patients suspected of having pulmonary tuberculosis |
| Authors: | Cattamanchi, Adithya
Dowdy, David W.
Davis, J. Lucian
Worodria, William
Yoo, Samuel
Joloba, Moses
Matovu, John
Hopewell, Philip C.
Huang, Laurence |
| Keywords: | HIV patients
TB patients
Smear microscopy in diagnosis |
| Issue Date: | 6-May-2009 |
| Publisher: | BioMed Central |
| Citation: | BMC Infectious Diseases 2009, 9:153 |
| Abstract: | Background: Sputum concentration increases the sensitivity of smear microscopy for the diagnosis of tuberculosis (TB), but few studies have investigated this method in human immunodeficiency virus (HIV)-infected
individuals.
Methods: We performed a prospective, blinded evaluation of direct and concentrated Ziehl-Neelsen smear microscopy on a single early-morning sputum sample in HIV-infected patients with > 2 weeks of cough hospitalized in Kampala, Uganda. Direct and concentrated smear results were compared with results of Lowenstein-Jensen culture.
Results: Of 279 participants, 170 (61%) had culture-confirmed TB. The sensitivity of direct and concentrated smear microscopy was not significantly different (51% vs. 52%, difference 1%, 95% confidence interval (CI): [-7%, 10%], p = 0.88). However, when results of both direct and concentrated smears were considered together, sensitivity was significantly increased compared with either method alone (64%, 95% CI: [56%, 72%], p < 0.01 for both comparisons) and was similar to that of direct smear results from consecutive (spot and early-morning) specimens (64% vs. 63%, difference 1%, 95% CI: [-6%, 8%], p = 0.85). Among 109 patients with negative cultures, one had a positive direct smear and 12 had positive concentrated smears (specificity 99% vs. 89%, difference 10%,
95% CI: [2%, 18%], p = 0.003). Of these 13 patients, 5 (38%) had improved on TB therapy after two months.
Conclusion: Sputum concentration did not increase the sensitivity of light microscopy for TB diagnosis in this HIV-infected population. Given the resource requirements for sputum concentration, additional studies using maximal blinding, high-quality direct microscopy, and a rigorous gold standard should be conducted before universally recommending this technique. |
| Description: | This article is available from: http://www.biomedcentral.com/1471-2334/9/53 |
| URI: | http://www.biomedcentral.com/1471-2334/9/53
http://hdl.handle.net/123456789/646 |
| ISSN: | 1471-2334 |
| Appears in Collections: | Research Articles (Bio-Medical)
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| Joloba-Worodria-microbiology-res.pdf | | 283Kb | Adobe PDF | View/Open |
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