Yield of Acid-fast Smear and Mycobacterial Culture for Tuberculosis Diagnosis in People with Human Immunodeficiency Virus
Yield of Acid-fast Smear and Mycobacterial Culture for Tuberculosis Diagnosis in People with Human Immunodeficiency Virus
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DOI：
10.1164/rccm.200905-0692oc
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发表时间：
2009-11-01
影响因子：
24.7
通讯作者：
Varma, Jay K.
中科院分区：
文献类型：
--
作者：
Monkongdee, Patama;McCarthy, Kimberly D.;Varma, Jay K.
理由：世界卫生组织最近修订了其关于艾滋病毒感染者结核病诊断的建议。支持这些政策的大多数研究涉及未感染艾滋病毒的患者，并且只评估了痰标本。目的：评价抗酸杆菌涂片和分枝杆菌培养对hiv感染者痰和非痰标本结核诊断的价值。方法：在泰国和越南，我们招募了艾滋病毒感染者，无论其体征或症状如何。纳入的患者提供三份痰、一份尿、一份便、一份血，对于可触摸的周围腺病患者，提供一份淋巴结抽吸标本用于抗酸杆菌显微镜检查和在固体和肉汤培养基上进行分枝杆菌培养。我们将任何至少有一个结核分枝杆菌标本培养阳性的患者归类为结核病。测量结果和主要结果：在1060例入组患者中，147例（14%）患有结核病。在126例肺结核患者中，在两次涂片中进行第三次痰涂片的增量产量为2%(95%置信区间为0-6)，90例（71%）患者通过第一次痰标本的肉汤培养被检测到，另外21例（17%）和12例（110%）患者通过培养第二次和第三次痰标本被诊断出来。在82个培养的淋巴结中，34个（42%）生长结核分枝杆菌。在两次痰涂片阴性的患者中，三个痰标本的肉汤培养在任何检测策略中产量最高。结论：在并非所有患者都能常规获得分枝杆菌培养的环境中生活的艾滋病毒感染者中，第三次痰涂片对结核病的诊断没有什么帮助。三种痰标本的肉汤培养诊断出大多数结核病病例，而淋巴结抽吸提供了任何非肺标本检测结核病的最高增量产量。
Rationale: The World Health Organization recently revised its recommendations for tuberculosis (TB) diagnosis in people with HIV. Most studies cited to support these policies involved HIV-uninfected patients and only evaluated sputum specimens.Objectives: To evaluate the performance of acid-fast bacilli smear and mycobacterial culture on sputum and nonsputum specimens for TB diagnosis in a cross-sectional survey of HIV-infected patients.Methods: In Thailand and Vietnam, we enrolled people with HIV regardless of signs or symptoms. Enrolled patients provided three sputum, one urine, one stool, one blood, and, for patients with palpable peripheral adenopathy, one lymph node aspirate specimen for acid-fast bacilli microscopy and mycobacterial culture on solid and broth-based media. We classified any patient with at least one specimen culture positive for Mycobacterium tuberculosis as having TB.Measurements and Main Results: Of 1,060 patients enrolled, 147 (14%) had TB. Of 126 with pulmonary TB, the incremental yield of performing a third sputum smear over two smears was 2% (95% confidence interval, 0-6), 90 (71%) patients were detected on broth-based culture of the first sputum specimen, and an additional 21 (17%) and 12 (110%) patients were diagnosed with the second and third specimens cultured. Of 82 lymph nodes cultured, 34 (42%) grew M. tuberculosis. In patients with two negative sputum smears, broth-based culture of three sputum specimens had the highest yield of any testing strategy.Conclusions: In people with HIV living in settings where mycobacterial culture is not routinely available to all patients, a third sputum smear adds little to the diagnosis of TB. Broth-based culture of three sputum specimens diagnoses most TB cases, and lymph node aspiration provides the highest incremental yield of any nonpulmonary specimen test for TB.