Giridharan Prathiksha, Inbaraj Leeberk Raja, Frederick Asha, Selvaraju Sriram, Ramraj Balaji, Thiruvengadam Kannan, Daniel Bella Davaleenal, Padmapriyadarsini Chandrasekaran
Department of Epidemiology, National Institute for Research in Tuberculosis Chennai, Chennai, India.
ICMR- National Instititute of Epidemiology, Chennai, India.
Sci Rep. 2025 Mar 18;15(1):9305. doi: 10.1038/s41598-025-94346-x.
Prevalence surveys and active case findings for tuberculosis (TB) typically use symptoms and Chest X-ray for screening and a diagnostic test for microbiological confirmation. We report the performance of screening and diagnostic tests from a state-wide prevalence survey in India. We screened 130,932 individuals using chest X-ray (CXR) and symptom checklist. Sputum samples were obtained from eligible participants and subjected to Xpert/MTB RIF, smear microscopy, and culture. Cough over two weeks had higher sensitivity (41.6%, 95% CI: 31.6-52.1) and lower specificity (72.8%, 95% CI: 72.1-73.5) among all the symptoms. The sensitivity and specificity of abnormal CXR were 86.4% (95% CI:77.9-92.5) and 42.12% (95% CI, 41.3-42.8), respectively. Xpert/MTB RIF in the reference laboratory had the highest sensitivity (96.55% 95% CI: 88.0-99.5), and smear microscopy had the highest specificity (99.7% 95% CI: 99.6-99.8). The combined sensitivity and specificity of Xpert MTB/RIF along symptom screening and CXR were 97.9% (95% CI:92.6-99.7) and 4.9% (95% CI:4.67-5.33), respectively. The mobile van Xpert MTB/RIF was found to be highly specific (99.3%). We recommend a diagnostic algorithm consisting of symptom screening and CXR followed by WHO-recommended rapid molecular assays (mWRD) for future prevalence surveys and active case finding.
结核病（TB）的患病率调查和主动病例发现通常使用症状和胸部X光进行筛查，并通过诊断测试进行微生物学确诊。我们报告了印度一项全州患病率调查中筛查和诊断测试的性能。我们使用胸部X光（CXR）和症状清单对130,932人进行了筛查。从符合条件的参与者中获取痰样本，并进行Xpert/MTB RIF、涂片显微镜检查和培养。在所有症状中，两周以上咳嗽的敏感性较高（41.6%，95%置信区间：31.6 - 52.1），特异性较低（72.8%，95%置信区间：72.1 - 73.5）。异常CXR的敏感性和特异性分别为86.4%（95%置信区间：77.9 - 92.5）和42.12%（95%置信区间，41.3 - 42.8）。参考实验室中的Xpert/MTB RIF敏感性最高（96.55%，95%置信区间：88.0 - 99.5），涂片显微镜检查特异性最高（99.7%，95%置信区间：99.6 - 99.8）。Xpert MTB/RIF联合症状筛查和CXR的敏感性和特异性分别为97.9%（95%置信区间：92.6 - 99.7）和4.9%（95%置信区间：4.67 - 5.33）。发现移动车Xpert MTB/RIF具有高度特异性（99.3%）。我们建议采用一种诊断算法，包括症状筛查和CXR，随后进行世界卫生组织推荐的快速分子检测（mWRD），用于未来的患病率调查和主动病例发现。
