Fakey Khan Dilshaad, Suleman Moosa, Baijnath Prinita, Perumal Rubeshan, Moodley Vedanthi, Mhlane Zoey, Naidoo Taryn, Ndung'u Thumbi, Wong Emily B
Department of Pulmonology, Inkosi Albert Luthuli Central Hospital, Durban, KZN, 4000, South Africa.
Center for the AIDS Programme of Research in South Africa, Durban, South Africa.
AAS Open Res. 2019 Jul 16;2:25. doi: 10.12688/aasopenres.12980.1. eCollection 2019.
Bronchoalveolar lavage (BAL) is indicated for medical evaluation of complex cases of lung disease. There is limited data on the performance of tuberculosis (TB) microbiologic tests on BAL in such patients, particularly in human immunodeficiency virus (HIV) and TB endemic areas. We evaluated the performance of (Mtb) culture and up to two simultaneous Xpert MTB/RIF tests on BAL fluid against a consensus clinical diagnosis in 98 medically complex patients undergoing bronchoscopy over a two-year period in Durban, South Africa. TB was the most frequently diagnosed lung disease, found in 19 of 98 participants (19%) and was microbiologically proven in 14 of these (74%); 9 (47%) were culture positive and 5 were positive on at least one Xpert MTB/RIF assay. Immunosuppression prevalence was high (26% HIV-infected, 29% on immunosuppressive therapy and 4% on chemotherapy). Xpert MTB/RIF had low sensitivity (45%) and high specificity (99%) when assessed against the consensus clinical diagnosis. Compared to TB culture, a single Xpert MTB/RIF increased the diagnostic yield by 11% and a second Xpert MTB/RIF by a further 16%. Although Xpert MTB/RIF had a low sensitivity, sending two tests improved the microbiologically-proven diagnostic yield of bronchoscopy from 47% to 74% compared to culture alone.
支气管肺泡灌洗（BAL）适用于对复杂肺部疾病病例进行医学评估。关于在此类患者中对BAL进行结核（TB）微生物学检测的性能数据有限，尤其是在人类免疫缺陷病毒（HIV）和结核病流行地区。我们在南非德班对98例在两年期间接受支气管镜检查的病情复杂的患者，评估了BAL液的结核分枝杆菌（Mtb）培养以及同时进行多达两次Xpert MTB/RIF检测相对于共识临床诊断的性能。TB是最常被诊断出的肺部疾病，在98名参与者中有19例（19%），其中14例（74%）经微生物学证实；9例（47%）培养呈阳性，5例在至少一次Xpert MTB/RIF检测中呈阳性。免疫抑制患病率很高（26%感染HIV，29%接受免疫抑制治疗，4%接受化疗）。与共识临床诊断相比，Xpert MTB/RIF的敏感性较低（45%），特异性较高（99%）。与TB培养相比，单次Xpert MTB/RIF检测使诊断率提高了11%，第二次Xpert MTB/RIF检测又提高了16%。尽管Xpert MTB/RIF的敏感性较低，但与单独培养相比，进行两次检测将支气管镜检查经微生物学证实的诊断率从47%提高到了74%。
