Evaluation of in-house PCR for diagnosis of smear-negative pulmonary tuberculosis in Kampala, Uganda

BMC Research Notes

Harriet Mayanja-Kizza²  Moses L Joloba⁴  Laurence Huang³  Achilles Katamba²  Fred A Katabazi⁴  Benon B Asiimwe⁴  Joseph B Sempa¹  William Worodria⁴  Ponsiano Ocama²  David P Kateete⁴  Lydia Nakiyingi² 

[1] Infectious Diseases Institute, Makerere University College of Health Sciences, Mulago Hospital Complex, Kampala, Uganda;Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;HIV/AIDS Division and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA;Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda

关键词: Resource limited settings;    Specificity;    Sensitivity;    Lowenstein-Jensen culture;    In-house PCR;    Nucleic acid amplification tests;    CD4 cell counts;    HIV-TB co-infection;    HIV-infected;    Smear-negative TB;    Pulmonary tuberculosis;   

Others  :  1165764
DOI  :  10.1186/1756-0500-5-487

 received in 2011-12-12, accepted in 2012-08-31,  发布年份 2012

【 摘 要 】

Background

Nucleic acid amplification tests (NAATs) have offered hope for rapid diagnosis of tuberculosis (TB). However, their efficiency with smear-negative samples has not been widely studied in low income settings. Here, we evaluated in-house PCR assay for diagnosis of smear-negative TB using Lowenstein-Jensen (LJ) culture as the baseline test. Two hundred and five pulmonary TB (PTB) suspects with smear-negative sputum samples, admitted on a short stay emergency ward at Mulago Hospital in Kampala, Uganda, were enrolled. Two smear-negative sputum samples were obtained from each PTB suspect and processed simultaneously for identification of MTBC using in-house PCR and LJ culture.

Results

Seventy two PTB suspects (35%, 72/205) were LJ culture positive while 128 (62.4%, 128/205) were PCR-positive. The sensitivity and specificity of in-house PCR for diagnosis of smear-negative PTB were 75% (95% CI 62.6-85.0) and 35.9% (95% CI 27.2-45.3), respectively. The positive and negative predictive values were 39% (95% CI 30.4-48.2) and 72.4% (95% CI 59.1-83.3), respectively, while the positive and negative likelihood ratios were 1.17 (95% CI 0.96-1.42) and 0.70 (95% CI 0.43-1.14), respectively. One hundred and seventeen LJ culture-negative suspects (75 PCR-positive and 42 PCR-negative) were enrolled for follow-up at 2 months. Of the PCR-positive suspects, 45 (60%, 45/75) were still alive, of whom 29 (64.4%, 29/45) returned for the follow-up visit; 15 (20%, 15/75) suspects died while another 15 (20%, 15/75) were lost to follow-up. Of the 42 PCR-negative suspects, 22 (52.4%, 22/42) were still alive, of whom 16 (72.7%, 16/22) returned for follow-up; 11 (26.2%, 11/42) died while nine (21.4%, 9/42) were lost to follow-up. Overall, more PCR-positive suspects were diagnosed with PTB during follow-up visits but the difference was not statistically significant (27.6%, 8/29 vs. 25%, 4/16, p = 0.9239). Furthermore, mortality was higher for the PCR-negative suspects but the difference was also not statistically significant (26.2% vs. 20% p = 0.7094).

Conclusion

In-house PCR correlates poorly with LJ culture for diagnosis of smear-negative PTB. Therefore, in-house PCR may not be adopted as an alternative to LJ culture.

【 授权许可】

   
2012 Nakiyingi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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