Sabella-Jiménez Vanessa, Sabella-Jiménez Valentina L, Restrepo-Espinosa Valentina, Eljadue-Flórez Juanita, Gallardo-Castro Claredit Valentina, Silvera Andrea Alexandra, Otero-Herrera Carlos, Arroyo Hugo Andrés Macareno, Acosta-Reyes Jorge, Barrios Jorge Luis Quintero
Department of Public Health, Universidad del Norte, Barranquilla, 080001, Colombia.
Department of Medicine, Universidad del Norte, Barranquilla, Colombia.
BMC Infect Dis. 2025 Apr 9;25(1):491. doi: 10.1186/s12879-025-10856-z.
Limited literature exists on the diagnostic yield of traditional and molecular tuberculosis (TB) tests using bronchoalveolar lavage (BAL) specimens in high burden South American countries. The aim of the study is to determine the value of acid-fast bacilli (AFB) smear microscopy and Xpert MTB/RIF using BAL samples for diagnosing pulmonary TB (PTB) in negative or sputum-scarce adults.
A cross-sectional, retrospective diagnostic accuracy study was carried out between January 1, 2015 and December 31, 2023. Demographic, clinical, imaging and microbiologic data were collected from consecutive medical records of initially negative or sputum-scarce adults, who underwent bronchoscopy due to presumptive PTB. Positive cultures were identified as Mycobacterium tuberculosis. Validity criteria was evaluated by sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and Cohen's kappa with their 95% confidence intervals using Wilson's score method by OpenEpi Version 3.01.
Of the 701 medical records screened, 283 adults were included. Cough (89.59%) and fever (64.31%) were the most frequent symptoms. Smear microscopy obtained a sensitivity of 39.22% (95% CI 27.03-52.92), specificity of 98.26% (95% CI 95.61-99.32), PPV of 83.33% (95% CI 64.15-93.32), NPV of 87.94% (95% CI 83.39-91.37) and Cohen's kappa of 0.472 (95% CI 0.3652-0.5788). Xpert MTB/RIF obtained a sensitivity of 91.67% (95% CI 80.45-96.71), specificity of 90.09% (95% CI 85.33-93.43), PPV of 67.69% (95% CI 55.61-77.8), NPV of 97.95% (95% CI 94.85-99.2) and Cohen's kappa of 0.7191 (95% CI 0.5998-0.8384).
Xpert MTB/RIF outperformed smear microscopy using BAL samples for the diagnosis of PTB in negative or sputum-scarce adults from a high burden Colombian setting. Due to rapid results, affordability and accessibility, particularly in resource-limited settings, smear microscopy should still be considered for BAL samples.
在结核病高负担的南美国家，关于使用支气管肺泡灌洗（BAL）标本进行传统和分子结核病（TB）检测的诊断率的文献有限。本研究的目的是确定在痰液阴性或稀少的成年人中，使用BAL样本进行抗酸杆菌（AFB）涂片显微镜检查和Xpert MTB/RIF检测对诊断肺结核（PTB）的价值。
在2015年1月1日至2023年12月31日期间进行了一项横断面回顾性诊断准确性研究。从因疑似PTB接受支气管镜检查的最初痰液阴性或稀少的成年人的连续病历中收集人口统计学、临床、影像学和微生物学数据。阳性培养物被鉴定为结核分枝杆菌。使用OpenEpi 3.01版的Wilson评分法，通过敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及Cohen's kappa及其95%置信区间来评估有效性标准。
在筛选的701份病历中，纳入了283名成年人。咳嗽（89.59%）和发热（64.31%）是最常见的症状。涂片显微镜检查的敏感性为39.22%（95%CI 27.03 - 52.92），特异性为98.26%（95%CI 95.61 - 99.32），PPV为83.33%（95%CI 64.15 - 93.32），NPV为87.94%（95%CI 83.39 - 91.37），Cohen's kappa为0.472（95%CI 0.3652 - 0.5788）。Xpert MTB/RIF的敏感性为91.67%（95%CI 80.45 - 96.71），特异性为90.09%（95%CI 85.33 - 93.43），PPV为67.69%（95%CI 55.61 - 77.8），NPV为97.95%（95%CI 94.85 - 99.2），Cohen's kappa为0.7191（95%CI 0.5998 - 0.8384）。
在哥伦比亚结核病高负担地区，对于痰液阴性或稀少的成年人，使用BAL样本进行PTB诊断时，Xpert MTB/RIF的表现优于涂片显微镜检查。由于结果快速且易于获得，尤其是在资源有限的环境中，对于BAL样本仍应考虑进行涂片显微镜检查。
