The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya

A Cattamanchi

A Martin

A Soto

A Tamhane

B Bah

CC Boehme

D Wilkinson

D Wilson

Delia Goletti

DH Mueller

Elisa Ardizzoni

Eric Okwaro

F Nackers

Francis Varaine

GI Mejia

GI Mejía

H Getahun

Helena Huerga

HF Swai

J Walley

JA Robledo

Jeremiah Chakaya

JL Davis

Joseph Sitienei

JR Landis

K Siddiqi

KP Cain

L Satti

LE Kivihya-Ndugga

M Pardini

Maryline Bonnet

Mathieu Bastard

MR van Cleef

O Koole

P Hepple

P Saranchuk

R Colebunders

S Rishi

VN Chihota

Y Kudjawu

English

PubMed

Huerga, H.

Varaine, F.

Okwaro, E.

Bastard, M.

Ardizzoni, E.

Sitienei, J.

Chakaya, J.

Bonnet, M.

Tropmed Central Antwerp

Performance of the 2007 WHO algorithm to diagnose smear-negative pulmonary tuberculosis in a HIV prevalent setting

<div><h3>Background</h3><p>The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including <em>Mycobacterium tuberculosis</em> (MTB) culture was evaluated in a HIV prevalent area of Kenya.</p> <h3>Methods</h3><p>PTB smear-negative adult suspects were included in a prospective diagnostic study (2009–2011). In addition, program data (2008–2009) were retrospectively analysed. At the first consultation, clinical examination, chest X-ray, and sputum culture (Thin-Layer-Agar and Lowenstein-Jensen) were performed. Patients not started on TB treatment were clinically re-assessed after antibiotic course. The algorithm performance was calculated using culture as reference standard.</p> <h3>Results</h3><p>380 patients were included prospectively and 406 analyzed retrospectively. Culture was positive for <em>MTB</em> in 17.5% (61/348) and 21.8% (72/330) of cases. Sensitivity of the clinical-radiological algorithm was 55.0% and 31.9% in the prospective study and the program data analysis, respectively. Specificity, positive and negative predictive values were 72.9%, 29.7% and 88.6% in the prospective study and 79.8%, 30.7% and 80.8% in the program data analysis. Performing culture increased the number of confirmed TB patients started on treatment by 43.3% in the prospective study and by 44.4% in the program data analysis. Median time to treatment of confirmed TB patients was 6 days in the prospective study and 27 days in the retrospective study. Inter-reader agreement for X-ray interpretation between the study clinician and a radiologist was low (Kappa coefficient = 0.11, 95%CI: 0.09–0.12). In a multivariate logistic analysis, past TB history, number of symptoms and signs at the clinical exam were independently associated with risk of overtreatment.</p> <h3>Conclusion</h3><p>The clinical-radiological algorithm is suboptimal to diagnose smear-negative PTB. Culture increases significantly the proportion of confirmed TB cases started on treatment. Better access to rapid <em>MTB</em> culture and development of new diagnostic tests is necessary.</p> </div

Helena Huerga (109527)

Francis Varaine (109532)

Eric Okwaro (109536)

Mathieu Bastard (109538)

Elisa Ardizzoni (109540)

Joseph Sitienei (109543)

Jeremiah Chakaya (109546)

Maryline Bonnet (89522)

FigShare

Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting

BACKGROUND: The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya. METHODS: PTB smear-negative adult suspects were included in a prospective diagnostic study (2009-2011). In addition, program data (2008-2009) were retrospectively analysed. At the first consultation, clinical examination, chest X-ray, and sputum culture (Thin-Layer-Agar and Lowenstein-Jensen) were performed. Patients not started on TB treatment were clinically re-assessed after antibiotic course. The algorithm performance was calculated using culture as reference standard. RESULTS: 380 patients were included prospectively and 406 analyzed retrospectively. Culture was positive for MTB in 17.5% (61/348) and 21.8% (72/330) of cases. Sensitivity of the clinical-radiological algorithm was 55.0% and 31.9% in the prospective study and the program data analysis, respectively. Specificity, positive and negative predictive values were 72.9%, 29.7% and 88.6% in the prospective study and 79.8%, 30.7% and 80.8% in the program data analysis. Performing culture increased the number of confirmed TB patients started on treatment by 43.3% in the prospective study and by 44.4% in the program data analysis. Median time to treatment of confirmed TB patients was 6 days in the prospective study and 27 days in the retrospective study. Inter-reader agreement for X-ray interpretation between the study clinician and a radiologist was low (Kappa coefficient = 0.11, 95%CI: 0.09-0.12). In a multivariate logistic analysis, past TB history, number of symptoms and signs at the clinical exam were independently associated with risk of overtreatment. CONCLUSION: The clinical-radiological algorithm is suboptimal to diagnose smear-negative PTB. Culture increases significantly the proportion of confirmed TB cases started on treatment. Better access to rapid MTB culture and development of new diagnostic tests is necessary

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Performance of the 2007 WHO algorithm to diagnose smear-negative pulmonary tuberculosis in a HIV prevalent setting.

Crossref

Huerga, H

Varaine, F

Okwaro, E

Bastard, M

Ardizzoni, E

Sitienei, J

Chakaya, J

Bonnet, M

MSF Field Research

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Performance of the 2007 WHO Algorithm to diagnose Smear-negative Pulmonary Tuberculosis in a HIV prevalent setting

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World Health Organization (2010) Report on conclusions and recommendations. Strategic and Technical Advisory Group For Tuberculosis. Geneva: WHO press. Available: http://www.who.int/tb/advisory_bodies/stag_tb_ report_2010.pdf.

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Performance of the 2007 WHO Algorithm to diagnose Smear-negative Pulmonary Tuberculosis in a HIV prevalent setting

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Directory of Open Access Journals

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MSF Field Research