Detection of Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary tuberculosis.
Detection of Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary tuberculosis.
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DOI：
10.1371/journal.pone.0177529
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Mihret A
中科院分区：
文献类型：
--
作者：
Abaye GE;Abebe T;Worku A;Tolessa D;Ameni G;Mihret A
由于人体免疫缺陷病毒（艾滋病毒）的流行，结核病的影响在非洲加剧。HIV感染者肺结核诊断困难，痰菌阴性多见，延误诊断，增加发病率和死亡率。肺外样本（如粪便）可能更容易获得，因此我们的方法可能会显着提高艾滋病毒感染者的PTB检测。从HIV血清阳性疑似肺结核患者粪便中检测结核分枝杆菌。来自埃塞俄比亚阿迪斯三家公共卫生机构的共计117名HIV感染者连续入组本研究。同时从未接受过抗逆转录病毒治疗（ART）的HIV感染者和疑似PTB患者中采集成对的早晨痰液和粪便样本。将粪便涂片镜检、培养和基于差异区（RD）9的聚合酶链反应（PCR）诊断的准确性与痰液检测的准确性进行比较。采用卡方检验和Kappa值对不同方法进行比较。在33例（28.2%）研究受试者中证实了痰培养分枝杆菌阳性。在33名粪便培养阳性的个体中，观察到10名个体粪便培养阳性。在痰培养阴性的84例患者中，3例（3.6%）粪便培养阳性，因此，粪便培养与痰培养的敏感性和一致性分别为30.3%和0.33。在117例患者中，11例（9.4%）痰涂片阳性，11例痰涂片阳性中有3例粪便涂片阳性。而106例痰涂片阴性者中，仅1例粪便涂片阳性，敏感性为12.1%，与痰培养的一致率为0.18。另一方面，以痰培养为参考标准，直接在粪便上进行基于RD 9的PCR的灵敏度为69.7%。此外，直接对痰进行基于RD 9的PCR检测到7例（6.0%）痰培养阴性的患者。结核M.在痰涂片镜检和培养阴性的艾滋病毒感染者的粪便中检出结核病。因此，粪便样本和痰液样本的检查增加了艾滋病毒感染者中PTB的检测。
The impact of tuberculosis (TB) is exacerbated in Africa because of the human immunodeficiency virus (HIV) pandemic. Pulmonary tuberculosis (PTB) diagnosis is difficult in HIV-infected patients and negative sputum results are more common which leads to diagnostic delay and increases morbidity and mortality. Extra-pulmonary samples such as stool may be easier to obtain and our approach may therefore significantly improve PTB detection in people living with HIV. To detect Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary TB. A total of 117 HIV-infected individuals from three public health facilities in Addis Ababa, Ethiopia were enrolled consecutively in the study. Paired morning sputum and stool samples were simultaneously collected from anti-retroviral therapy (ART) naïve individuals living with HIV and suspected for PTB. The diagnostic accuracy of the smear microscopy, culture and region of difference (RD)9–based polymerase chain reaction (PCR) in stool was compared with the accuracy of sputum testing. Chi-square test and kappa value were used to compare different method used. Sputum culture positivity for mycobacteria was confirmed in 33(28.2%) of the study subjects. Of 33 individuals positive for sputa culture, 10 individuals were observed to be stools culture positive. Of the 84 individuals negative for mycobacteria by sputum culture, three (3.6%) were stool culture positive and thus, the sensitivity and agreement between stool culture as compare to sputum culture were 30.3% and 0.33, respectively. Of 117 individuals, 11(9.4%) were sputum smear positive and of 11 sputum smear positive three were also stool smear positive. While of the 106 sputum smear negative individuals’, only one was stool smear positive resulting in 12.1% sensitivity and 0.18 agreements against sputum culture. On the other hand, the sensitivity of RD9-based PCR directly on stool was 69.7% by considering sputum culture as a reference standard. Moreover, RD9-based PCR directly on sputum detected 7(6.0%) individuals who were sputum culture negative for M. tuberculosis. M. tuberculosis was detected in stool of individuals living with HIV who were negative for sputum smear microscopy and culture. Hence, examination of stool samples alongside with sputum samples increases the detection of PTB in individuals living with HIV.