Monkongdee Patama, McCarthy Kimberly D, Cain Kevin P, Tasaneeyapan Theerawit, Nguyen H Dung, Nguyen T N Lan, Nguyen T B Yen, Teeratakulpisarn Nipat, Udomsantisuk Nibondh, Heilig Charles, Varma Jay K
Thailand Ministry of Public Health - U.S. CDC Collaboration, Nonthaburi, Thailand.
Am J Respir Crit Care Med. 2009 Nov 1;180(9):903-8. doi: 10.1164/rccm.200905-0692OC. Epub 2009 Jul 23.
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.
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.
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.
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 (10%) 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.
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.
世界卫生组织最近修订了其针对艾滋病毒感染者结核病（TB）诊断的建议。大多数被引用来支持这些政策的研究涉及未感染艾滋病毒的患者，且仅评估了痰标本。
在一项针对艾滋病毒感染患者的横断面调查中，评估抗酸杆菌涂片和分枝杆菌培养在痰标本和非痰标本上对结核病诊断的性能。
在泰国和越南，我们纳入了无论有无体征或症状的艾滋病毒感染者。纳入的患者提供三份痰标本、一份尿液、一份粪便、一份血液，对于有可触及外周淋巴结肿大的患者，提供一份淋巴结穿刺标本，用于抗酸杆菌显微镜检查以及在固体和基于肉汤的培养基上进行分枝杆菌培养。我们将任何至少有一份标本培养出结核分枝杆菌阳性的患者分类为患有结核病。
在纳入的1060例患者中，147例（14%）患有结核病。在126例肺结核患者中，进行第三次痰涂片相对于两次涂片的额外检出率为2%（95%置信区间，0 - 6），90例（71%）患者通过对第一份痰标本进行基于肉汤的培养被检测出，另外21例（17%）和12例（10%）患者分别通过对第二份和第三份培养的标本被诊断出。在82例培养的淋巴结中，34例（42%）培养出结核分枝杆菌。在痰涂片两次阴性的患者中，对三份痰标本进行基于肉汤的培养在所有检测策略中检出率最高。
在结核分枝杆菌培养并非所有患者都能常规进行的环境中，艾滋病毒感染者进行第三次痰涂片对结核病诊断的帮助不大。对三份痰标本进行基于肉汤的培养可诊断出大多数结核病病例，淋巴结穿刺在所有非肺部标本结核病检测中提供的额外检出率最高。
