Sensitivity of direct versus concentrated sputum smear microscopy in HIV-infected patients suspected of having pulmonary tuberculosis.
Sensitivity of direct versus concentrated sputum smear microscopy in HIV-infected patients suspected of having pulmonary tuberculosis.
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DOI：
10.1186/1471-2334-9-53
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发表时间：
2009-05-06
影响因子：
3.7
通讯作者：
Huang L
中科院分区：
文献类型：
--
作者：
Cattamanchi A;Dowdy DW;Davis JL;Worodria W;Yoo S;Joloba M;Matovu J;Hopewell PC;Huang L
痰液浓度增加了涂片显微镜诊断结核病（TB）的敏感性，但很少有研究调查这种方法在人类免疫缺陷病毒（HIV）感染的个体。我们对在乌干达坎帕拉住院的咳嗽> 2周的HIV感染患者的单个清晨痰样本进行了直接和浓缩Ziehl-Neelsen涂片显微镜检查的前瞻性、盲法评价。将直接涂片和浓缩涂片结果与罗氏培养结果进行比较。在279名参与者中，170名（61%）患有培养确认的结核病。直接和浓缩涂片镜检的灵敏度无显著差异（51% vs. 52%，差异1%，95%置信区间（CI）：[-7%，10%]，p = 0.88）。然而，当直接涂片和浓缩涂片的结果一起考虑时，与单独使用任何一种方法相比，灵敏度显著增加（64%，95% CI：[56%，72%]，两次比较p < 0.01），与连续性直接涂片结果相似。（现场和清晨）标本（64% vs. 63%，差异1%，95% CI：[-6%，8%]，p = 0.85）。在109例阴性培养患者中，1例直接涂片阳性，12例浓缩涂片阳性（特异性99% vs. 89%，差异10%，95% CI：[2%，18%]，p = 0.003）。在这13名患者中，5名（38%）在结核病治疗两个月后有所改善。在HIV感染人群中，痰液浓度并没有增加光学显微镜对结核病诊断的敏感性。考虑到痰液浓缩的资源需求，在普遍推荐该技术之前，应使用最大盲法、高质量直接显微镜和严格的金标准进行额外研究。
Sputum concentration increases the sensitivity of smear microscopy for the diagnosis of tuberculosis (TB), but few studies have investigated this method in human immunodeficiency virus (HIV)-infected individuals. We performed a prospective, blinded evaluation of direct and concentrated Ziehl-Neelsen smear microscopy on a single early-morning sputum sample in HIV-infected patients with > 2 weeks of cough hospitalized in Kampala, Uganda. Direct and concentrated smear results were compared with results of Lowenstein-Jensen culture. Of 279 participants, 170 (61%) had culture-confirmed TB. The sensitivity of direct and concentrated smear microscopy was not significantly different (51% vs. 52%, difference 1%, 95% confidence interval (CI): [-7%, 10%], p = 0.88). However, when results of both direct and concentrated smears were considered together, sensitivity was significantly increased compared with either method alone (64%, 95% CI: [56%, 72%], p < 0.01 for both comparisons) and was similar to that of direct smear results from consecutive (spot and early-morning) specimens (64% vs. 63%, difference 1%, 95% CI: [-6%, 8%], p = 0.85). Among 109 patients with negative cultures, one had a positive direct smear and 12 had positive concentrated smears (specificity 99% vs. 89%, difference 10%, 95% CI: [2%, 18%], p = 0.003). Of these 13 patients, 5 (38%) had improved on TB therapy after two months. Sputum concentration did not increase the sensitivity of light microscopy for TB diagnosis in this HIV-infected population. Given the resource requirements for sputum concentration, additional studies using maximal blinding, high-quality direct microscopy, and a rigorous gold standard should be conducted before universally recommending this technique.