Characteristics and Early Outcomes of Patients With Xpert MTB/RIF-Negative Pulmonary Tuberculosis Diagnosed During Screening Before Antiretroviral Therapy

Lawn, Stephen D.; Kerkhoff, Andrew D.; Vogt, Monica; Ghebrekristos, Yonas; Whitelaw, Andrew; Wood, Robin

doi:10.1093/cid/cir1039

Cited by 69 publications

(66 citation statements)

References 20 publications

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“…A modest neutrophilic response was common in tuberculosis: even survivors with active tuberculosis had higher median neutrophil counts than healthy contacts. Others have reported that higher blood neutrophil counts correlate with sputum M. tuberculosis PCR positivity and, especially, smear positivity [7], while separate studies discovered higher neutrophil counts associated with slower conversion of sputum culture to negative [5,6]. Together with the higher prevalence of neutrophilia in patients who die (reported here), these results suggest that, broadly speaking, the neutrophil count in tuberculosis positively correlates with bacillary load.…”

Section: Neutrophilia Independently Predicts Death In Tuberculosissupporting

confidence: 65%

Neutrophilia independently predicts death in tuberculosis: Table 1–

et al. 2013

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Section: Neutrophilia Independently Predicts Death In Tuberculosissupporting

confidence: 65%

Neutrophilia independently predicts death in tuberculosis: Table 1–

et al. 2013

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“…9,[49][50][51] The performance of all tests tends to be less good due to lower sensitivity when used for screening than for patient-initiated diagnostic testing, as the spectrum of undiagnosed disease detected is shifted towards earlier, paucibacillary cases (Figures 2 and 3): this includes culture, smear microscopy and Xpert. 30,41,49,50,[52][53][54] There is considerable incremental yield from combining different tests, or repeating the same test on different specimens. 30,53,55 All tests also have relatively low positive predictive value when used for screening, due to the lower prevalence of true disease.…”

Section: Optimal Screening Strategies For Different Priority Groupsmentioning

confidence: 99%

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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SUMMARYTwenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality.More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal.In the present study, we review the evidence available to guide expanded TB screening in HIVprevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. In high human immunodeficiency virus (HIV) prevalence settings, population-level tuberculosis (TB) incidence increased in parallel with adult HIV prevalence in the 1990s and remains extremely high, with over 1% of adults diagnosed with TB each year in many Southern African towns. 1 Outbreaks of multi-and extensively drug-resistant TB (XDR-TB) have been generated in HIV care clinics, and then spread into general communities. 2,3 Autopsy studies show that TB is the single biggest killer of people living with HIV (PLHIV), being the cause in 32% to 45% of HIV-related deaths 4 and with a high proportion of fatal cases undiagnosed in life. 4,5 Of the estimated 430 000 TB-related deaths among PLHIV during 2011, 79% were in Africa. These stark facts demonstrate the urgent need to strengthen TB prevention and care services using all available approaches, including more ambitious TB screening strategies.TB screening is the first step in both anti-tuberculosis treatment and TB prevention pathways, and has an integral place in routine HIV care and infection control. Key potential entry points for TB screening are illustrated in Figure 1. TB screening c...

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“…The Xpert MTB/RIF assay is highly sensitivity and much faster than sputum microscopy 35 . Therefore, the rate of detection is increased by 45%, when compared with sputum microscopy, for the patients those are infected by HIV 36 . The Xpert MTB/RIF assay has the possibilities to improve the performance of national tuberculosis programs and currently being implemented in 67 countries 3 .…”

Section: Active Tuberculosismentioning

confidence: 99%