Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade Federal do Amazonas, Manaus, Brazil.
Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade Federal do Amazonas, Manaus, Brazil; Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil.
Int J Infect Dis. 2021 Apr;105:743-745. doi: 10.1016/j.ijid.2021.03.022. Epub 2021 Mar 17.
Bacteriological confirmation of extrapulmonary tuberculosis (EPTB) is challenging for several reasons: the paucibacillary nature of the sample; scarce resources, mainly in middle and low-income countries; the need for hospitalization; and unfavorable outcomes. We evaluated the diagnostic role of respiratory specimen examination prospectively in a cohort of patients with presumptive EPTB.
From July 2018 to January 2019, in a tuberculosis (TB)/HIV reference hospital, a cohort of 157 patients with presumed EPTB was evaluated. Xpert® MTB/RIF Ultra or a culture-positive result was considered for bacteriologically confirmed TB.
Out of 157 patients with presumptive EPTB, 97 (62%) provided extrapulmonary and respiratory specimens and 60 (38%) extrapulmonary specimens only. Of the 60 patients with extrapulmonary samples, 5 (8%) were positive. Of those with respiratory and extrapulmonary samples, 27 (28%) were positive: 10 in both the respiratory and extrapulmonary samples, 6 in the extrapulmonary sample only, and 11 in the respiratory sample only. A respiratory specimen examination increased by 6-fold the chance of bacteriological confirmation of TB (odds ratio = 5.97 [1.11-47.17]).
We conclude that respiratory samples should be examined in patients with presumptive EPTB.
由于多种原因，肺外结核病（EPTB）的细菌学确诊具有挑战性：标本数量少；中低收入国家主要缺乏资源；需要住院治疗；以及不良预后。我们前瞻性评估了疑似 EPTB 患者队列中呼吸道标本检查的诊断作用。
在 2018 年 7 月至 2019 年 1 月期间，在一家结核病（TB）/HIV 参考医院，评估了 157 例疑似 EPTB 的患者队列。Xpert® MTB/RIF Ultra 或培养阳性结果被认为是细菌学确诊结核病的依据。
在 157 例疑似 EPTB 的患者中，97 例（62%）提供了肺外和呼吸道标本，60 例（38%）仅提供了肺外标本。在 60 例有肺外样本的患者中，有 5 例（8%）呈阳性。在有呼吸道和肺外样本的患者中，有 27 例（28%）呈阳性：10 例在呼吸道和肺外样本中均为阳性，6 例仅在肺外样本中阳性，11 例仅在呼吸道样本中阳性。呼吸道标本检查使结核病细菌学确诊的机会增加了 6 倍（优势比=5.97[1.11-47.17]）。
我们的结论是，疑似 EPTB 患者应检查呼吸道样本。
