Diagnostic validity of an expert tuberculosis commission that assists the diagnosis of bacteriologically negative suspected TB cases in Havana, Cuba

Abstract

The Provincial Tuberculosis Commission of Havana, Cuba, a multi-speciality committee, assists clinicians in diagnosing bacteriologically negative tuberculosis (TB). At its weekly meetings, clinicians present the files of suspected TB cases for discussion, diagnosis and recommendations. This prospective study assessed the validity of the diagnoses made by the Commission by comparing the diagnoses made with diagnoses ascertained after one year of follow-up. Between October 2002 and December 2003, 126 patients suspected to have TB but who were bacteriologically negative completed diagnostic work at the Commission. Fifty-three (42%) were diagnosed as TB cases. The definite diagnosis of 116 patients (92%) was ascertained after one year of follow-up. Six patients diagnosed by the Commission as TB cases were suffering from other diseases, while one patient diagnosed with pneumonia had a definite diagnosis of pulmonary TB. The diagnostic sensitivity and specificity of the Commission were 98% (95% CI 93-100) and 92% (95% CI 85-98), respectively. The Provincial Tuberculosis Commission of Havana can be considered a valuable tool for the diagnosis of TB in patients suspected of TB but who are bacteriologically negative. A comparable approach, adapted to the local conditions, could prove useful in other epidemiological and healthcare settings.

Validation of a Clinical-Radiographic Score to Assess the Probability of Pulmonary Tuberculosis in Suspect Patients with Negative Sputum Smears

“…This could affect the wider applicability of our findings, but it reflects utilisation patterns and current clinical practice, certainly in large parts of Latin America, where patients with clinical suspicion of pulmonary tuberculosis and negative smears are usually referred to higher level facilities to establish a diagnosis with additional tests and/or make treatment decisions based on expert opinion [26]. However, the presence of diseases such as COPD amongst TB suspects may be higher at referral level.…”

Performance of an algorithm based on WHO recommendations for the diagnosis of smear‐negative pulmonary tuberculosis in patients without HIV infection

“…Nevertheless, additional smears can be associated with patients’ loss to follow‐up (Foulds & O’Brien 1998). On the other hand, we standardized the clinical and radiological evaluation by using a clinical prediction rule that has been locally derived, which should have improved the reliability of the clinical evaluation component of the algorithm, just as an expert panel does (Matthys et al. 2009).…”