Swai Hedwiga F, Mugusi Ferdinand M, Mbwambo Jessie K
Department of Internal Medicine Muhimbili National Hospital, Dar-es-salaam, +255 Tanzania.
BMC Res Notes. 2011 Nov 1;4:475. doi: 10.1186/1756-0500-4-475.
The diagnosis of pulmonary tuberculosis in patients with Human Immunodeficiency Virus (HIV) is complicated by the increased presence of sputum smear negative tuberculosis. Diagnosis of smear negative pulmonary tuberculosis is made by an algorithm recommended by the National Tuberculosis and Leprosy Programme that uses symptoms, signs and laboratory results.The objective of this study is to determine the sensitivity and specificity of the tuberculosis treatment algorithm used for the diagnosis of sputum smear negative pulmonary tuberculosis.
A cross-section study with prospective enrollment of patients was conducted in Dar-es-Salaam Tanzania. For patients with sputum smear negative, sputum was sent for culture. All consenting recruited patients were counseled and tested for HIV. Patients were evaluated using the National Tuberculosis and Leprosy Programme guidelines and those fulfilling the criteria of having active pulmonary tuberculosis were started on anti tuberculosis therapy. Remaining patients were provided appropriate therapy. A chest X-ray, mantoux test, and Full Blood Picture were done for each patient. The sensitivity and specificity of the recommended algorithm was calculated. Predictors of sputum culture positive were determined using multivariate analysis.
During the study, 467 subjects were enrolled. Of those, 318 (68.1%) were HIV positive, 127 (27.2%) had sputum culture positive for Mycobacteria Tuberculosis, of whom 66 (51.9%) were correctly treated with anti-Tuberculosis drugs and 61 (48.1%) were missed and did not get anti-Tuberculosis drugs. Of the 286 subjects with sputum culture negative, 107 (37.4%) were incorrectly treated with anti-Tuberculosis drugs. The diagnostic algorithm for smear negative pulmonary tuberculosis had a sensitivity and specificity of 38.1% and 74.5% respectively. The presence of a dry cough, a high respiratory rate, a low eosinophil count, a mixed type of anaemia and presence of a cavity were found to be predictive of smear negative but culture positive pulmonary tuberculosis.
The current practices of establishing pulmonary tuberculosis diagnosis are not sensitive and specific enough to establish the diagnosis of Acid Fast Bacilli smear negative pulmonary tuberculosis and over treat people with no pulmonary tuberculosis.
人类免疫缺陷病毒（HIV）感染者的肺结核诊断因痰涂片阴性肺结核病例增多而变得复杂。痰涂片阴性肺结核的诊断依据国家结核病和麻风病防治规划推荐的一种算法，该算法综合运用症状、体征和实验室检查结果。本研究的目的是确定用于诊断痰涂片阴性肺结核的结核病治疗算法的敏感性和特异性。
在坦桑尼亚达累斯萨拉姆进行了一项前瞻性纳入患者的横断面研究。对于痰涂片阴性的患者，将痰液送去培养。所有同意参与的招募患者均接受了咨询并进行了HIV检测。按照国家结核病和麻风病防治规划指南对患者进行评估，符合活动性肺结核标准的患者开始接受抗结核治疗。其余患者接受适当治疗。为每位患者进行了胸部X光检查、结核菌素试验和血常规检查。计算推荐算法的敏感性和特异性。使用多变量分析确定痰培养阳性的预测因素。
在研究期间，共纳入467名受试者。其中，318名（68.1%）为HIV阳性，127名（27.2%）痰培养结核分枝杆菌阳性，其中66名（51.9%）接受了正确的抗结核药物治疗，61名（48.1%）被漏诊，未接受抗结核药物治疗。在286名痰培养阴性的受试者中，107名（37.4%）接受了错误的抗结核药物治疗。痰涂片阴性肺结核的诊断算法敏感性和特异性分别为38.1%和74.5%。干咳、呼吸频率高、嗜酸性粒细胞计数低、混合性贫血以及有空洞被发现是痰涂片阴性但培养阳性肺结核的预测因素。
目前确立肺结核诊断的方法在诊断抗酸杆菌涂片阴性肺结核方面敏感性和特异性不足，且对无肺结核的人存在过度治疗的情况。
