Clinical and radiographic factors do not accurately diagnose smear-negative tuberculosis in HIV-infected inpatients in Uganda: a cross-sectional study.
Clinical and radiographic factors do not accurately diagnose smear-negative tuberculosis in HIV-infected inpatients in Uganda: a cross-sectional study.
复制标题
DOI：
10.1371/journal.pone.0009859
复制
发表时间：
2010-03-26
期刊：
影响因子：
3.7
通讯作者：
Huang L
中科院分区：
文献类型：
--
作者：
Davis JL;Worodria W;Kisembo H;Metcalfe JZ;Cattamanchi A;Kawooya M;Kyeyune R;den Boon S;Powell K;Okello R;Yoo S;Huang L
尽管世界卫生组织指南建议通过临床判断和胸部X光检查来诊断患有不明原因咳嗽且痰涂片抗酸杆菌阴性的HIV感染者的结核病，但这种方法的诊断性能尚不清楚。因此，我们试图评估症状、体征和影像学结果在结核病高发低收入国家的人群中诊断结核病的准确性。我们进行了一项横断面研究，招募了乌干达坎帕拉穆拉戈医院连续出现不明原因咳嗽且痰涂片抗酸杆菌阴性的 HIV 感染住院患者。训练有素的医务人员前瞻性地收集了系统性呼吸道疾病的标准症状和体征的数据，两名放射科医生以标准化的方式解读了胸部X光片。我们计算了这些因素诊断肺结核的阳性和阴性似然比（当痰或支气管肺泡灌洗液的分枝杆菌培养呈阳性时定义）。我们使用传统和新颖的回归技术来开发肺结核的多变量预测模型。在 202 名痰涂片抗酸杆菌阴性的 HIV 感染成人中，72 人（36%）患有肺结核培养阳性。没有任何单一因素，包括呼吸道症状、体检结果、CD4+ T 细胞计数或胸部放射学异常，可以显着增加或减少肺结核的可能性。经过详尽的测试，我们也无法确定任何能够可靠预测细菌学确诊的结核病的因素组合。临床和放射学标准无助于诊断低收入环境中出现不明原因咳嗽的艾滋病毒感染者的涂阴性肺结核。迫切需要加强涂阴结核病的诊断方法。
Although World Health Organization guidelines recommend clinical judgment and chest radiography for diagnosing tuberculosis in HIV-infected adults with unexplained cough and negative sputum smears for acid-fast bacilli, the diagnostic performance of this approach is unknown. Therefore, we sought to assess the accuracy of symptoms, physical signs, and radiographic findings for diagnosing tuberculosis in this population in a low-income country with a high incidence of tuberculosis. We performed a cross-sectional study enrolling consecutive HIV-infected inpatients with unexplained cough and negative sputum smears for acid-fast bacilli at Mulago Hospital in Kampala, Uganda. Trained medical officers prospectively collected data on standard symptoms and signs of systemic respiratory illness, and two radiologists interpreted chest radiographs in a standardized fashion. We calculated positive- and negative-likelihood ratios of these factors for diagnosing pulmonary tuberculosis (defined when mycobacterial cultures of sputum or bronchoalveolar lavage fluid were positive). We used both conventional and novel regression techniques to develop multivariable prediction models for pulmonary tuberculosis. Among 202 enrolled HIV-infected adults with negative sputum smears for acid-fast bacilli, 72 (36%) had culture-positive pulmonary tuberculosis. No single factor, including respiratory symptoms, physical findings, CD4+ T-cell count, or chest radiographic abnormalities, substantially increased or decreased the likelihood of pulmonary tuberculosis. After exhaustive testing, we were also unable to identify any combination of factors which reliably predicted bacteriologically confirmed tuberculosis. Clinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting. Enhanced diagnostic methods for smear-negative tuberculosis are urgently needed.
登录
查看更多内容
影响因子：
168.9
作者：
Khan, Mishal Sameer;Dar, Osman;Godfrey-Faussett, Peter
通讯作者：
Godfrey-Faussett, Peter
影响因子：
5
作者：
Pepe, MS;Janes, H;Newcomb, P
通讯作者：
Newcomb, P
影响因子：
9.6
作者：
Kanaya, AM;Glidden, DV;Chambers, HF
通讯作者：
Chambers, HF
影响因子：
9.6
作者：
El-Solh, AA;Hsiao, CB;Grant, BJB
通讯作者：
Grant, BJB
影响因子：
3.7
作者：
Cattamanchi A;Dowdy DW;Davis JL;Worodria W;Yoo S;Joloba M;Matovu J;Hopewell PC;Huang L
通讯作者：
Huang L