Pulmonary tuberculosis: Evaluation of current diagnostic strategy - 28/04/21
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Highlights |
• | Systematic use of fibroscopy procedure among acid-fast negative patients is pivotal in reducing time to diagnosis, especially when using molecular testing. |
• | Tuberculosis diagnosis algorithms can be optimized to fit peculiar epidemiological settings in developed countries, and predefined diagnosis protocols could be developed in such centers. |
• | A high suspicion score of tuberculosis could drive the reasoned use of molecular testing in such settings. |
Abstract |
Objective |
To identify tools that will result in faster diagnosis, making the current pulmonary tuberculosis strategy more efficient.
Patients and methods |
A 4-year (2015–2018) retrospective study. The gold standard for diagnosis was a positive culture from a respiratory specimen. All sputum, fibroscopy and post-fibroscopy specimens (for smear negative patients) were collected. Each specimen was analyzed through smear examination and culture. All nucleic acid amplification testing results were included. Analyses looked at the incremental yield of positive cases of each successive specimen collection, and time to diagnosis.
Results |
A total of 354 patients had at least one positive culture. Sputum allowed a diagnosis in 92% of cases (including a gain in sensitivity of around 7% for the third sputum specimen), with 160 smear-positive patients (45%). Among smear-negative patients, 109 underwent a fibroscopy procedure (culture sensitivity of 75%), and 59 had a post-fibroscopy specimen collected, which together identified the rest of the patients (8%). Molecular testing was used in 237 specimens. Median time to diagnosis was 11 days, which was significantly reduced among smear-negative patients when molecular testing was used (P<0.001). Shortening the delay between sputum specimen collections did not alter procedure sensitivity.
Conclusions |
We identified several aspects of the French tuberculosis diagnosis algorithm that could be improved, and posed the basis for a prospective study. Centers in higher incidence areas could benefit from a dedicated, predefined procedure exploring suspicions of tuberculosis. A high suspicion score of tuberculosis could drive the reasoned use of molecular testing in such settings.
Le texte complet de cet article est disponible en PDF.Keywords : Tuberculosis diagnosis, Diagnostic tests, Early diagnosis, Nucleic acid amplification techniques, Sputum
Plan
| ☆ | Partial data of this paper was presented at the French meeting of infectious diseases in Lyon, France (June 5th-7th, 2019). |
Vol 51 - N° 3
P. 273-278 - mai 2021 Retour au numéro
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