Risk factors in patients with AFB smear-positive sputum who receive inappropriate antituberculous treatment

Chang, Chung-Yi; Hong, Jen-Yee; Yuan, Mei-Kang; Su, Chang; Lee, Yuan-Ming; Chang, Shih‐Chieh; Hsu, Li-Cho; Cheng, Shin-Lung

doi:10.2147/dddt.s39247

Cited by 15 publications

(14 citation statements)

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“…However, the administration of unnecessary empiric anti-TB treatment is not uncommon in real world practice and patients might suffer from the adverse effects of anti-TB drugs. Our colleagues (Shih-Chieh Chang, et al) issued an article that revealed 40.4% of patients with positive sputum AFB stains did not have pulmonary TB in Taiwan [ 20 ]. According to Chang’s results, among patients who had positive sputum AFB stains without pulmonary TB, 25.8% were prescribed anti-TB treatment and 44% of them developed various adverse effects (hepatitis: 32%; skin rash: 20%).…”

Section: Discussionmentioning

confidence: 99%

Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum

et al. 2014

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BackgroundEarly diagnosis and treatment of nontuberculous mycobacterial lung diseases (NTM-LD) and pulmonary tuberculosis (PTB) are important clinical issues. The present study aimed to compare and identify the chest CT characteristics that help to distinguish NTM lung disease from PTB in patients with acid-fast bacilli (AFB) smear-positive sputum.MethodsFrom January 2009 to April 2012, we received 467 AFB smear-positive sputum specimens. A total of 95 CT scans obtained from the 159 patients were analyzed, 75 scans were from patients with PTB and 20 scans from NTM-LD. The typical chest CT findings of mycobacterial diseases were analyzed.ResultsIn patients with PTB, the prevalence of pleural effusion (38.7% vs. 15.0%; P =0.047), nodules < 10 mm in size (76.0% vs. 25.0%; P < 0.001), tree-in-bud pattern (81.3% vs. 55.0%; P =0.021), and cavities (31.1% vs. 5.0%; P =0.018) were significantly higher than patients with NTM. Of the 20 patients with NTM lung diseases, bronchiectasis and cystic changes were significantly higher than patients with PTB (20.0% vs. 4.0%; P = 0.034). In multivariate analysis, CT scan findings of nodules was independently associated with patients with diagnoses of PTB (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02-0.30). Presence of bronchiectasis and cystic changes in CT scans was strongly associated with patients with NTM-LD (OR, 33.04; 95% CI, 3.01-362.55).ConclusionsThe CT distinction between NTM-LD and PTB may help radiologists and physicians to know the most likely diagnoses in AFB-smear positive patients and avoid unnecessary adverse effects and the related costs of anti-TB drugs in endemic areas.

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Section: Discussionmentioning

confidence: 99%

Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum

et al. 2014

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“…Only about 20 -40% of pulmonary TB patients are smear-positive, while rest of the patients had either smear-negative or sputum-scarce disease. [5,6] The key to this challenge is having a more accurate and rapid diagnostic modality and obtaining a high-quality biological specimen. Bronchoscopy with Bronchoalveolar Lavage (BAL) is routinely performed for these set of patients in a suspected case of pulmonary tuberculosis.…”

Section: Introductionmentioning

confidence: 99%

Comparison Studies of GENXPERT versus MGIT Culture of Bronchial Lavage in Sputum Smear Negative Suspected Pulmonary Tuberculosis

Uppe¹,

Sharma²,

Sawant³

et al. 2018

AJIDM

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Introduction: Xpert MTB/RIF (Cepheid, USA) is an automated real-time PCR system that simultaneously detects TB and resistance to rifampicin. The test has excellent accuracy when performed on sputum and is endorsed by the World Health Organisation (WHO) and the USA Federal Drug Administration. Aims: To measure the diagnostic yield of bronchoalveolar lavage gene Xpert and compare it with traditional mycobacterial cultures in smear-negative and sputum-scarce pulmonary tuberculosis. Methods: A prospective observational study at a tertiary care hospital in India was conducted. A total of 200 patients who were 18 years or older under evaluation for clinico-radiological features of PTB with a history of a cough >2 weeks and a chest X-ray with pulmonary parenchymal involvement were recruited after ensuring two consecutive sputum negative smears or inability to produce adequate sputum. A volume of one ml of BAL sample was used to detect mycobacterium tuberculosis by the G4 version of Xpert ® MTB/RIF (Cepheid, USA) and by traditional mycobacterial cultures. cartridges without initial decontamination or centrifugation. Sensitivity, specificity and predictive values were calculated with 95% class intervals (CIs). McNemar's test was used for comparison of sensitivities. Result: The results showed that the AFB smear test had 76.83% (95% CI: 66.20-85.44) sensitivity, 100.0% (95% CI: 96.92-100.0) specificity with 100.% PPV and 86.13% (95%CI: 80.72-90.21) NPV compared to culture report.

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“…Patients with positive AFB smear results may be directly diagnosed as PTB and received a long-term antituberculosis treatment, in the absence of specimen culture and strain identi cation. According to Chang's study, of the patients with AFB smear-positive sputum but no PTB, 18.5% were later diagnosed with NTM-LD, and 32% were a icted with NTM colonization [20]. Once NTM-LD is misdiagnosed as PTB and given chemotherapy, there will be not only a high risk of adverse reactions, but also a long course of treatment, poor e cacy, and a heavy economic burden [7,8].…”

Section: Discussionmentioning

confidence: 99%

Establishment and Validation of a Predictive Model for Non-tuberculous Mycobacterial Infections in Acid-fast Bacilli Smear-positive Patients

Chen

Zhang

et al. 2020

Preprint

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Background: To identify non-tuberculous mycobacteria (NTM) infections in initially acid-fast bacilli (AFB) smear-positive patients more quickly and effectively, we attempted to establish a predictive model and validate it in clinical practice.Methods: A total of 125 AFB smear-positive patients with mycobacteriosis diagnosed in the Respiratory Department of Shanghai Pulmonary Hospital were retrospectively analyzed，including 64 cases of NTM and 61 cases of pulmonary tuberculosis (PTB), to identify the clinical features distinguishing NTM from PTB patients. A bivariate regression was then set up to determine the independent predictive risk factors to NTM infections. A receiver operating characteristic (ROC) curve was used to determine the model’s predictive discrimination. Finally, the model was verified both internally and externally for its predictive ability.Results: Compared with PTB, female patient, the symptom of hemoptysis, the exists of bronchiectasis, and negative test for QuantiFERON tuberculosis (QFT) were more common in NTM patients (78.1% vs. 34.4%, 37.5% vs. 11.5%, 76.6% vs. 19.7%, 82.8% vs. 8.2%, respectively, P≤0.001). The lesions on chest high-resolution computed tomography (HRCT) in NTM patients were more commonly involved in the right middle lobe (87.5% vs. 52.5%, P<0.001) and left lingular lobe (71.9% vs. 50.8%, P=0.016), and cystic change was more commonly morphological alteration (32.8% vs. 8.2%, P=0.001). Binary regression analysis showed that female patient, the exists of bronchiectasis, negative test for QFT and right middle lobe lesion were independent risk factors for NTM in AFB smear-positive patients (P<0.05). A ROC curve combining the four risk factors showed a sensitivity and specificity of 85.9% and 93.4%, respectively, and the area under the curve (AUC) was 0.963. Moreover, internal validation and external validation of the later clinical data both confirmed the effectiveness of the model.Conclusions: The predictive model would be useful for early differential diagnosis of NTM in initially AFB smear-positive patients.

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Risk factors in patients with AFB smear-positive sputum who receive inappropriate antituberculous treatment

Cited by 15 publications

References 14 publications

Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum

Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum

Comparison Studies of GENXPERT versus MGIT Culture of Bronchial Lavage in Sputum Smear Negative Suspected Pulmonary Tuberculosis

Establishment and Validation of a Predictive Model for Non-tuberculous Mycobacterial Infections in Acid-fast Bacilli Smear-positive Patients

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