Factors Associated With Sputum Culture-Negative vs Culture-Positive Diagnosis of Pulmonary Tuberculosis

Nguyen, Mimi; Levy, Natalie S.; Ahuja, Shama D.; Trieu, Lisa; Proops, Douglas; Achkar, Jacqueline M.

doi:10.1001/jamanetworkopen.2018.7617

Cited by 33 publications

(44 citation statements)

References 30 publications

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“…In the patients with extensive lung lesions, 72.28% (206/285) of whom was mainly cavity type lesion and 56.31% of whom was mostly thick-walled cavity (56.31%). This was similar to the previous study 17,18 which reported that sputum positive pulmonary tuberculosis had a good correlation with cavity, while the thick wall was composed of fiber tissue, inflammatory granulation tissue and caseous necrotic substance, and the thickness of the wall was positively correlated with the sputum bacterial load 19 . The existence of this lesion type and other risk factors may be one of the pathological bases for the easier progress of intrapulmonary lesions.…”

Section: Discussionsupporting

confidence: 91%

A valuable computed tomography-based new diagnostic tool for severe chest lesions in active pulmonary tuberculosis: combined application of influencing factors

Jiang

Zhu

et al. 2020

Sci Rep

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The objective of the present investigation was to explore the influencing factors and value of computed tomography (ct) for diagnosing severe chest lesions in active pulmonary tuberculosis (AptB). this retrospective investigation included 463 patients diagnosed with APTB. Relevant clinical features were collected. patients were assigned to mild/moderate group or advanced group depending on the lesion severity on chest CT, severe chest CT lesion refers to the moderately dense or less diffuse lesion that exceeds the total volume of one lung, or the dense fusion lesion greater than one third of the volume of one lung, or the lesion with cavity diameter ≥4 cm. Independent risk factors for severe lesions were determined by univariate and multivariate logistic regression analyses, and the diagnostic efficiency of the risk factors was assessed by receiver operating characteristic curve (ROC). Chest CT demonstrated that there were 285 (61.56%) cases with severe lesions; multivariate Logistic regression analysis showed dust exposure [odds ratio (oR) = 4.108, 95% confidence interval (CI) 2.416-6.986], patient classification (OR = 1.792, 95% CI 1.067-3.012), age (OR = 1.018, 95% CI 1.005-1.030), and albuminglobulin ratio (oR = 0.179, 95% CI 0.084-0.383) to be independently correlated with severe lesions on chest CT. ROC curve analysis showed the cutoff values of age, albumin-globulin ratio and combined score to be 39 years, 0.918 and −0.085, respectively. The predictive value of combined score area under the curve 0.753 (95% CI 0.708-0.798) was higher than that of any single factor. The combined score of these four factors further improved the predictive efficacy.

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Section: Discussionsupporting

confidence: 91%

A valuable computed tomography-based new diagnostic tool for severe chest lesions in active pulmonary tuberculosis: combined application of influencing factors

Jiang

Zhu

et al. 2020

Sci Rep

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“…Regarding demographic factors, gender and age were found related to bacteriological results in some studies. [16,19] In our study, although the older age were over presented in the bacteriologically con rmed group, after adjusted with other factors, age as well as gender were not statistically signi cant. Compared with state employees, the unemployed and farmers usually had disadvantage in household income and living conditions, leading them vulnerable to TB.…”

Section: Discussioncontrasting

confidence: 55%

“…Cavitation on chest X-ray usually means enriched bacteria in the lesion and represents later stage of the disease, and cough can produce sputum containing MTB from the lesion to the air through droplets, increasing the possibility to detect MTB in sputum samples, which is in consistent with previous studies. [4,16,19,20] Similarly, blood sputum and bilateral lung affected may re ect extensive lesion, which were also found to increase BC proportion. Diabetes comorbidity were found to be associated with higher grading of sputum smear among TB patients in other studies.…”

Section: Discussionmentioning

confidence: 93%

“…[15] In New York 85% of the pulmonary TB patients were culture positive. [16] The gap may re ect different background of TB prevalence in countries/regions, and also partly attribute to different pro le of patient characteristics. Apart from factors relating to laboratory, patients with speci c characteristics tend to have pauci-bacillary, such as HIV co-infection, children, and mild clinical manifestations.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of different bacteriological testing strategies and factors for bacteriological confirmation among pulmonary TB patients: a retrospective study in Tianjin, China, 2017-2018

Zhang

Chen

et al. 2020

Preprint

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Abstract Background Bacteriological confirmation (BC) proportion among notified pulmonary TB patients in China is among the lowest in the world. This study was to understand the yield of BC using different testing strategies and patient-level factors associated with BC among pulmonary TB patients in Tianjin, China during 2017-2018.Methods A retrospective study was conducted, enrolling pulmonary TB patients reported to National TB Information Management System (TIMS) in Tianjin during 2017-2018. BC was defined as a positive result by any of the followings: smear microscopy, culture, or nucleic acid amplification test. Individual characteristics were compared between patients with positive and negative bacteriological results using contingency tables and c2 test. Multivariable logistic regression was applied to analyze factors associated with BC, calculating adjusted odds ratios (aOR) and 95% confidence intervals (CI) (α=0.05).Results Of 6,364 reported patients, 4,181 (65.7%) were bacteriologically confirmed. Positivity proportion was 43.1% (2,746/6,364) for smear microscopy, 57.7% (3,380/5,853) for culture, 61.7% (1,608/2,605) for Xpert® MTB/RIF assay (Xpert) and 73.4% (1,824/2,484) for combination of the three. The unemployed (aOR=1.5, 95% CI: 1.0-2.2) and farmers (aOR=1.7, 95% CI: 1.1-2.8) compared with students; diagnosis by inpatient hospitals compared with TB clinics (aOR=3.4, 95% CI: 2.6-4.4); having symptoms for ≥2 weeks (aOR=1.4, 95% CI: 1.1-1.8); cough (aOR=2.2, 95% CI: 1.8-2.8); blood sputum (aOR=1.5, 95% CI: 1.0-2.2); cavitation on chest X-ray (aOR=3.3, 95% CI: 2.5-4.3); bilateral lung lobes affected (aOR=1.7, 95% CI: 1.4-2.2) were factors associated with BC.Conclusions Combination tests was an effective way to improve BC among pulmonary TB patients. Being unemployed, farmers, having prolonged symptoms, and more severe in TB condition were factors associated with BC. We recommend combination of tests to improve BC for pulmonary TB patients, especially who are in early stage of the disease or with conditions tend to be bacteriologically negative.

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“…It was also reported that Mycobacterium was frequently not identified using 16S rDNA sequencing even in samples with positive cultures for these organisms. In addition, 20% to 30% of patients with TB are diagnosed clinically due to lack of culture confirmation [10]. To date, the lung microbiome in MTB-positive (MTB+) and MTB-negative (MTB-) lung samples has not been analyzed.…”

Section: Introductionmentioning

confidence: 99%

Metagenomic analysis of the lung microbiome in pulmonary tuberculosis - a pilot study

Cheng

Liu

et al. 2020

Emerging Microbes & Infections

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The lung microbiome plays an important role in the pathophysiological processes associated with pulmonary tuberculosis (PTB). However, only a few studies using 16S rDNA amplicon sequencing have been reported, and the interactions between Mycobacterium tuberculosis (MTB) and the lung microbiome remain poorly understood. Patients with respiratory symptoms and imaging abnormalities compatible with tuberculosis (TB) were enrolled. We analyzed the lung microbiome in bronchoalveolar lavage (BAL) samples from 30 MTB-positive (MTB+) subjects and 30 MTB negative (MTB-) subjects by shotgun metagenomic sequencing. Alpha diversity tended to be lower in the MTB+ group than in the MTB-group. There was a significant difference in beta diversity between the MTB+ and MTB-subjects. MTB+ lung samples were dominated by MTB, while MTB-samples were enriched with Streptococcus, Prevotella, Nesseria, Selenomonas and Bifidobacterium, which more closely resemble the microbial composition of a healthy lung. Network analysis suggested that MTB could greatly impact the microbial community structure. MTB+ and MTB-communities showed distinct functional signatures. Fungal communities were also found to be associated with the presence or absence of MTB. Furthermore, it was confirmed that 16S rDNA amplicon sequencing underrepresents Mycobacterium. This pilot study is the first to explore the interplay between MTB and the host microbiome by using metagenomic sequencing. MTB dominates the lung microbiome of MTB+ subjects, while MTB-subjects have a Streptococcus-enriched microbiome. The 16S approach underrepresents Mycobacterium and is not the best way to study the TB-associated microbiome.

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Factors Associated With Sputum Culture-Negative vs Culture-Positive Diagnosis of Pulmonary Tuberculosis

Cited by 33 publications

References 30 publications

A valuable computed tomography-based new diagnostic tool for severe chest lesions in active pulmonary tuberculosis: combined application of influencing factors

A valuable computed tomography-based new diagnostic tool for severe chest lesions in active pulmonary tuberculosis: combined application of influencing factors

Comparison of different bacteriological testing strategies and factors for bacteriological confirmation among pulmonary TB patients: a retrospective study in Tianjin, China, 2017-2018

Metagenomic analysis of the lung microbiome in pulmonary tuberculosis - a pilot study

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