Center for Clinical Microbiology, University College, London, UK.
University of Zambia and University College London Medical School Research and Training Programme, Lusaka, Zambia.
Trop Med Int Health. 2013 Sep;18(9):1134-1140. doi: 10.1111/tmi.12145. Epub 2013 Jul 3.
In high-tuberculosis (TB)-endemic countries, comorbidity of pulmonary TB in hospitalised patients with non-communicable diseases is well documented. In this study, we evaluated the use of the Xpert(®) MTB/RIF assay for the detection of concomitant pulmonary TB in patients admitted to the University Teaching Hospital, Lusaka, Zambia, with a primary obstetric or gynaecological condition.
The Study population were inpatients admitted with a primary obstetric or gynaecological problem who had a concomitant cough and were able to expectorate a sputum sample. Sputum samples from 94 patients were analysed for the presence of Mycobacterium tuberculosis (M.tb) by standard smear microscopy, MGIT culture, MGIT drug-susceptibility testing (DST) and the Xpert(®) MTB/RIF assay. The sensitivity and specificity of the Xpert(®) MTB/RIF assay were evaluated against the culture gold standard.
Twenty-six of 94 (27.7%) patients had culture-confirmed pulmonary TB. The Xpert(®) MTB/RIF assay had a sensitivity of 80.8% [95% CI: 60.0-92.7%]) compared against MGIT culture. The Xpert(®) MTB/RIF assay was more sensitive than sputum smear microscopy (21/26 (80.8%) vs. 13/26 (50.0%), P = 0.02) and detected an additional eight culture-confirmed cases. Culture DST analysis identified two monoresistant M.tb strains: one resistant to rifampicin (rifampicin sensitive by the Xpert(®) MTB/RIF assay) and one to ethambutol. HIV infection was linked with a 3-fold increase in risk of TB, accounting for 87.5% (21/24) of TB cases. 50% of cases presented as comorbidities with other communicable diseases (CDs) and non-communicable diseases (NCDs).
As an alternative to sputum microscopy, the Xpert(®) MTB/RIF assay provides a sensitive, specific and rapid method for the diagnosis of pulmonary TB in obstetric or gynaecological inpatients. Pulmonary TB is an important cause of concomitant comorbidity to the obstetric or gynaecological condition necessitating admission. TB and HIV comorbidities with other communicable and non-communicable diseases were also common. More proactive screening for TB comorbidity is required in obstetric and gynaecological wards.
在结核病高发国家，住院的非传染性疾病患者中同时患有肺结核的情况已有大量文献记载。在这项研究中，我们评估了 Xpert® MTB/RIF 检测在赞比亚卢萨卡大学教学医院因原发性产科或妇科疾病住院的患者中检测同时存在的肺结核的应用。
研究人群为因原发性产科或妇科问题入院且伴有伴随性咳嗽并能够咳出痰样标本的患者。对 94 例患者的痰样标本进行了标准涂片显微镜检查、MGIT 培养、MGIT 药物敏感性试验（DST）和 Xpert® MTB/RIF 检测，以检测是否存在结核分枝杆菌（M.tb）。以 MGIT 培养为金标准，评估 Xpert® MTB/RIF 检测的敏感性和特异性。
94 例患者中有 26 例（27.7%）经培养证实患有肺结核。Xpert® MTB/RIF 检测的敏感性为 80.8%（95%CI：60.0-92.7%），与 MGIT 培养相比。与痰涂片显微镜检查（21/26（80.8%）比 13/26（50.0%），P=0.02）相比，Xpert® MTB/RIF 检测更敏感，并检测到另外 8 例经培养证实的病例。培养药敏分析发现两种单耐药 M.tb 株：一种对利福平耐药（Xpert® MTB/RIF 检测呈利福平敏感），一种对乙胺丁醇耐药。HIV 感染使结核病风险增加了 3 倍，占结核病病例的 87.5%（21/24）。50%的病例同时患有其他传染病（CDs）和非传染性疾病（NCDs）。
作为痰涂片检查的替代方法，Xpert® MTB/RIF 检测为产科或妇科住院患者的肺结核提供了一种敏感、特异和快速的方法。肺结核是产科或妇科疾病入院的重要伴发性疾病。肺结核和 HIV 与其他传染病和非传染病的合并症也很常见。需要在产科和妇科病房更积极地筛查肺结核合并症。
