Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence

Siddiqi, Kamran; Lambert, Marie‐Laurence; Walley, John

doi:10.1016/s1473-3099(03)00609-1

Cited by 274 publications

(235 citation statements)

References 18 publications

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“…Sputum smear microscopy is the primary tool for the diagnosis of TB in most countries. Although AFB microscopy is inexpensive, it lacks accuracy (sensitivity of 45-80% with culture-confirmed PTB cases), is labour-intensive and does not detect patients with smear-negative disease, mainly HIV-infected persons (Siddiqi et al 2003, CDC 2009, WHO 2009). Bacterial culture is the most sensitive of the currently available tests and permits species identification and drug sensitivity tests.…”

mentioning

confidence: 99%

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Michelon

Rosso

Schmid

et al. 2011

Mem. Inst. Oswaldo Cruz

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mentioning

confidence: 99%

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Michelon

Rosso

Schmid

et al. 2011

Mem. Inst. Oswaldo Cruz

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“…15,24 The study has some limitations. A number of TB cases were recorded as pulmonary 'smear not done'.…”

Section: Discussionmentioning

confidence: 98%

“…Smear-negative PTB is more common in children, the elderly and HIV co-infected patients. [15][16][17] In addition, programmatic factors may affect the diagnosis of smear-negative PTB. For example, patients may not submit high quality sputum specimens, the correct number of specimens may not be submitted, staining of sputum specimens for diagnosis in the laboratory may be suboptimal, clinicians may rely on CXR and symptoms to make a diagnosis, and errors in recording and reporting may be made.…”

Section: Discussionmentioning

confidence: 99%

Sputum smear examination and time to diagnosis in patients with smear-negative pulmonary tuberculosis in the Pacific

Viney

Bissell

Tabutoa

et al. 2012

public health action

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is performed, read and interpreted by a clinician, and a clinical assessment. This may result in delays in diagnosis, 6 which in turn can be associated with progression of disease, worse treatment outcome and spread of TB in the community. [7][8][9] To our knowledge, there is little local or published evidence about the practice of or time taken for diagnosing smear-negative PTB in the Pacifi c Islands, although TB surveillance data are reported annually. 1,2 These data report the proportion of all TB cases diagnosed as PTB (both smear-positive and smear-negative) and extra-pulmonary TB, but do not report the number of smears for each case, how this relates to the age and sex of the patients or the time taken for diagnosis. 1,2 Furthermore, one possible reason for an overdiagnosis of smear-negative PTB is that sputum smear examinations are not performed according to national guidelines. Patients may be being diagnosed without laboratory investigation, with the diagnosis based instead only on clinical criteria and CXR fi ndings.We therefore decided to investigate the practice of sputum smear examination in the Pacifi c Islands, focusing on two countries in the subregion of Micronesia where the TB burden is highest. The aim of this study was to determine the practice of sputum smear examination in patients registered with smear-negative PTB over a 5-year period in Kiribati and the Marshall Islands. Specifi c objectives were to determine: 1) the number and proportion of all TB patients registered with smear-negative PTB; 2) in patients registered with smear-negative PTB, whether or not smears were performed and the number of sputum smear examinations performed in relation to age and sex; and 3) the time taken between smear examination in the laboratory and recording the patient as smear-negative PTB in the TB patient register. METHODS DesignThis study was a retrospective, cross-sectional study involving a record review of TB patient registers and TB laboratory registers. SettingThe setting is two Micronesian Pacifi c Island countries, Kiribati and the Marshall Islands. Kiribati is an equatorial country, located about halfway between Australia and Hawaii, while the Marshall Islands are located in the northern Pacifi c. Kiribati is an independent nation, while the Marshall Islands are affi liated with the United States under a Compact of Free Association. Interna onal Union Against Tuberculosis and Lung Disease

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“…Lack of accurate and rapid diagnostic methods for pulmonary tuberculosis has been a major problem for global tuberculosis control especially for SNPT [24]. NAATs were introduced as hopeful novel tests for pulmonary tuberculosis and a lot of commercial assays were introduced into the market [25].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis

et al. 2015

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SynopsisThe diagnosis of smear-negative pulmonary tuberculosis (SNPT) remains a clinical challenge. Many studies suggest that nucleic acid amplification tests (NAATs) on bronchoalveolar lavage fluid (BALF) plays a role in diagnosing SNPT, but with considerable varying results. The current study aimed to summarize the overall diagnostic accuracy of NAATs assay on BALF for SNPT. A systematic literature search was performed and data were retrieved. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were calculated. A summary receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the overall diagnostic performance. All the statistical analysis was performed by using STATA 12.0 and Meta-DiSc 1.4 software. A total of nine studies with 1214 subjects were included this meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 0.

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Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence

Cited by 274 publications

References 18 publications

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Sputum smear examination and time to diagnosis in patients with smear-negative pulmonary tuberculosis in the Pacific

Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis

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