Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia

Adi, Mateus Sakundarno; Nurjazuli, Nurjazuli; Jati, Sutopo Patria; Sariningdyah, Retna; Purwadi, Sumarsono; Alisjahbana, Bachti; Werf, Marieke J. van der

doi:10.1186/1471-2466-9-16

Cited by 33 publications

(39 citation statements)

References 5 publications

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“…Even with these shortcomings the substantial increase in bacterial load observed in VV versus NV sputum samples suggests that simple visual inspection may be a potential method of assessing sample quality. Our results support a growing body of evidence that suggests that emphasis on collecting and testing higher-quality samples is a relatively simple low-cost way to improve operational sensitivity (30)(31)(32)(33)(34). Studies that use M. tuberculosis Cts to compare bacterial load within or between patients should ensure samples of comparable quality are being assessed.…”

Section: Discussionsupporting

confidence: 74%

A Multisite Assessment of the Quantitative Capabilities of the Xpert MTB/RIF Assay

Blakemore¹,

Nabeta

Davidow³

et al. 2011

Am J Respir Crit Care Med

105

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Rationale: The Xpert MTB/RIF is an automated molecular test for Mycobacterium tuberculosis that estimates bacterial burden by measuring the threshold-cycle (Ct) of its M. tuberculosis-specific real-time polymerase chain reaction. Bacterial burden is an important biomarker for disease severity, infection control risk, and response to therapy. Objectives: Evaluate bacterial load quantitation by Xpert MTB/RIF compared with conventional quantitative methods. Methods: Xpert MTB/RIF results were compared with smear-microscopy, semiquantiative solid culture, and time-to-detection in liquid culture for 741 patients and 2,008 samples tested in a multisite clinical trial. An internal control real-time polymerase chain reaction was evaluated for its ability to identify inaccurate quantitative Xpert MTB/RIF results. Measurements and Main Results: Assays with an internal control Ct greater than 34 were likely to be inaccurately quantitated; this represented 15% of M. tuberculosis-positive tests. Excluding these, decreasing M. tuberculosis Ct was associated with increasing smear microscopy grade for smears of concentrated sputum pellets (r s ¼ 20.77) and directly from sputum (r s ¼ 20.71). A Ct cutoff of approximately 27.7 best predicted smear-positive status. The association between M. tuberculosis Ct and time-to-detection in liquid culture (r s ¼ 0.68) and semiquantitative colony counts (r s ¼ 20.56) was weaker than smear. Tests of paired same-patient sputum showed that highviscosity sputum samples contained 332 more M. tuberculosis than nonviscous samples. Comparisons between the grade of the acid-fast bacilli smear and Xpert MTB/RIF quantitative data across study sites enabled us to identify a site outlier in microscopy. Conclusions: Xpert MTB/RIF quantitation offers a new, standardized approach to measuring bacterial burden in the sputum of patients with tuberculosis.Keywords: tuberculosis; molecular diagnostics; diagnostic techniques and procedures; diagnosis; clinical trial Measurements of bacterial load have long played an important role in tuberculosis diagnostics. Semiquantitative or quantitative measures of the number of Mycobacterium tuberculosis bacilli present within a clinical sample have been clinically useful for determining disease severity, assessing transmission risk, or monitoring therapy (1-3). Quantitative readouts have also aided in the investigation of potentially false-positive results (4-6).The Xpert MTB/RIF (Cepheid, Sunnyvale, CA) assay simultaneously detects the presence of M. tuberculosis and its susceptibility to the important first-line drug rifampin in less than 2 hours (7). The assay is contained in a small plastic cartridge, and it is run on the GeneXpert platform (Cepheid), a diagnostic The Xpert MTB/RIF assay is a rapid diagnostic test for tuberculosis and rifampin resistance. A number of studies have examined the sensitivity and specificity of the assay in various clinical settings and with various sample types. The test can also provide an estimate of the bacterial load present in the s...

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Section: Discussionsupporting

confidence: 74%

A Multisite Assessment of the Quantitative Capabilities of the Xpert MTB/RIF Assay

Blakemore¹,

Nabeta

Davidow³

et al. 2011

Am J Respir Crit Care Med

105

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“…It is difficult to confirm on bacteriological examination of sputum, notably if only microscopy is available [3,4]. …”

Section: Introductionmentioning

confidence: 99%

High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: a cross sectional study

2011

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BackgroundChildhood tuberculosis (TB) has been neglected in the fight against TB. Despite implementation of Directly Observed Treatment Shortcourse (DOTS) program in public and private hospitals in Indonesia since 2000, the burden of childhood TB in hospitals was largely unknown. The goals of this study were to document the caseload and types of childhood TB in the 0-4 and 5-14 year age groups diagnosed in DOTS hospitals on Java Island, Indonesia.MethodsCross-sectional study of TB cases recorded in inpatient and outpatient registers of 32 hospitals. Cases were analyzed by hospital characteristics, age groups, and types of TB. The number of cases reported in the outpatient unit was compared with that recorded in the TB register.ResultsOf 5,877 TB cases in the inpatient unit and 15,694 in the outpatient unit, 11% (648) and 27% (4,173) respectively were children. Most of the childhood TB cases were under five years old (56% and 53% in the inpatient and outpatient clinics respectively). The proportion of smear positive TB was twice as high in the inpatient compared to the outpatient units (15.6% vs 8.1%). Extra-pulmonary TB accounted for 15% and 6% of TB cases in inpatient and outpatient clinics respectively. Among children recorded in hospitals only 1.6% were reported to the National TB Program.ConclusionIn response to the high caseload and gross under-reporting of childhood TB cases, the National TB Program should give higher priority for childhood TB case management in designated DOTS hospitals. In addition, an international guidance on childhood TB recording and reporting and improved diagnostics and standardized classification is required

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“…As in many other tests of pulmonary function (39,40), cough-generated aerosol production is effort dependent and probably varies with motivation, strength, sense of well-being, and other factors. However, collection of sputum specimens is also limited by similar issues (41,42).…”

Section: Limitationsmentioning

confidence: 99%

Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

Fennelly

Jones-López

Ayakaka

et al. 2012

Am J Respir Crit Care Med

133

137

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Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia

Cited by 33 publications

References 5 publications

A Multisite Assessment of the Quantitative Capabilities of the Xpert MTB/RIF Assay

A Multisite Assessment of the Quantitative Capabilities of the Xpert MTB/RIF Assay

High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: a cross sectional study

Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

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