Integrated Strategies to Optimize Sputum Smear Microscopy A Prospective Observational Study
Integrated Strategies to Optimize Sputum Smear Microscopy A Prospective Observational Study
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DOI：
10.1164/rccm.201008-1207oc
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发表时间：
2011-02-15
影响因子：
24.7
通讯作者：
Davis, J. Lucian
中科院分区：
文献类型：
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作者：
Cattamanchi, Adithya;Huang, Laurence;Davis, J. Lucian
基本原理：在大多数低收入国家，痰阳性结核病病例检出率远低于目标。涂片显微镜的标准方法包括在数天内收集痰液，并通过光学显微镜（LM）检查痰液，这是一种不敏感且耗时的技术。目的：探讨两种可选方法是否能通过提高评估结核病疑似病例的效率（单标本镜检）或灵敏度（发光二极管[LED]荧光镜检[FM]）来增加痰检阳性病例的检出率。方法：选取乌干达坎帕拉市穆拉戈医院收治的咳嗽2周及以上的患者，采集现场和清晨痰标本。我们以分枝杆菌培养为参考标准，基于收集的痰标本数量（一个标本与两个标本）和显微镜类型（LM与LED FM），比较了四种预先指定策略的诊断准确性。测量和主要结果：464例患者中有233例（50%）结核培养阳性。当使用LM检查涂片时，单标本和双标本策略之间的灵敏度没有差异（55比56%；差异，-1%；95%置信区间[Cl]， 5到+2%）或LED FM（61比64%；差异，-3%;95% Cl， 7到+1%）。在单样品（61比55%；差异，6%;95% Cl, 2-10%）和双样品策略（64比56%；差异，8%;95% Cl, 3-12%）下，LED FM比LM更敏感。在hiv感染患者亚群（n = 321例患者）中发现相似。结论：在低收入、高结核病负担环境中，单标本显微镜和LED FM，无论是单独使用还是联合使用，都可以显著增加痰检阳性结核病病例的识别。
Rationale Smear-positive tuberculosis (TB) case detection rates are far below targets in most low-income countries. The standard approach to smear microscopy involves sputum collection over multiple days and examination of sputum smears by light microscopy (LM), an insensitive and time-consuming technique.Objective: To determine whether two alternative approaches can increase smear-positive case detection by increasing the efficiency (single-specimen microscopy) or sensitivity (light-emitting diode [LED] fluorescence microscopy [FM]) of TB suspect evaluation.Methods: We enrolled patients with cough of 2 weeks or more admitted to Mulago Hospital in Kampala, Uganda and collected spot and early morning sputum specimens. We compared the diagnostic accuracy of four prespecified strategies based on the number of sputum specimens collected (one specimen versus two specimens) and the type of microscopy (LM versus LED FM) using mycobacterial culture as a reference standard.Measurements and Main Results: Two hundred thirty-three of 464 (50%) patients had culture-positive TB. There was no difference in sensitivity between single-specimen and two-specimen strategies when smears were examined with LM (55 vs. 56%; difference, -1%; 95% confidence interval [Cl], 5 to +2%) or LED FM (61 vs. 64%; difference, -3%; 95% Cl, 7 to +1%). LED FM was more sensitive than LM with both the single-specimen (61 vs. 55%; difference, 6%; 95% Cl, 2-10%) and two-specimen strategies (64 vs. 56%; difference, 8%; 95% Cl, 3-12%). Findings were similar among the HIV-infected patient subset (n = 321 patients).Conclusions: In low-income, high TB burden settings, single-specimen microscopy and LED FM, either alone or in combination, could considerably increase identification of smear-positive TB cases.