从疑似肺结核的HIV血清阳性个体粪便中检测结核分枝杆菌。
Detection of Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary tuberculosis.
作者信息
Abaye Gizaw E, Abebe Tamrat, Worku Adane, Tolessa Debela, Ameni Gobena, Mihret Adane
机构信息
Department of Medical Laboratory Science, College of Health Sciences, Arsi University, Asella, Ethiopia.
Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
PLoS One. 2017 May 19;12(5):e0177529. doi: 10.1371/journal.pone.0177529. eCollection 2017.
BACKGROUND
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.
OBJECTIVE
To detect Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary TB.
METHOD
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.
RESULTS
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.
CONCLUSION
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.
背景
由于人类免疫缺陷病毒（HIV）大流行，结核病（TB）在非洲的影响更为严重。在HIV感染患者中，肺结核（PTB）的诊断较为困难，痰检结果阴性更为常见，这导致诊断延迟并增加发病率和死亡率。粪便等肺外样本可能更容易获取，因此我们的方法可能会显著提高HIV感染者中PTB的检测率。
目的
从疑似肺结核的HIV血清阳性个体的粪便中检测结核分枝杆菌。
方法
连续纳入来自埃塞俄比亚亚的斯亚贝巴三个公共卫生机构的117名HIV感染者。同时从未接受抗逆转录病毒治疗（ART）且疑似患有PTB的HIV感染者中采集配对的清晨痰液和粪便样本。将粪便涂片显微镜检查、培养及基于差异区域（RD）9的聚合酶链反应（PCR）的诊断准确性与痰液检测的准确性进行比较。采用卡方检验和kappa值来比较不同方法。
结果
33名（28.2%）研究对象的痰液培养证实为分枝杆菌阳性。在33名痰液培养阳性的个体中，观察到10名个体粪便培养阳性。在84名痰液培养分枝杆菌阴性的个体中，3名（3.6%）粪便培养阳性，因此，与痰液培养相比，粪便培养的敏感性和一致性分别为30.3%和0.33。在117名个体中，11名（9.4%）痰液涂片阳性，在11名痰液涂片阳性者中，3名粪便涂片也呈阳性。而在106名痰液涂片阴性的个体中，只有1名粪便涂片阳性，与痰液培养相比，敏感性为12.1%，一致性为0.18。另一方面，以痰液培养为参考标准，直接对粪便进行基于RD9的PCR检测的敏感性为69.7%。此外，直接对痰液进行基于RD9的PCR检测出7名（6.0%）痰液培养结核分枝杆菌阴性的个体。
结论
在痰液涂片显微镜检查和培养均为阴性的HIV感染者的粪便中检测到了结核分枝杆菌。因此，同时检查粪便样本和痰液样本可提高HIV感染者中PTB的检测率。
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