1. Rapid diagnosis of pulmonary tuberculosis by combined molecular and immunological methods
- Author
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C. Jafari, Christoph Lange, Martin Ernst, Jan Heyckendorf, Franziska Daduna, Ioana D. Olaru, and Barbara Kalsdorf
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tuberculosis ,Presumptive diagnosis ,Sensitivity and Specificity ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pulmonary tuberculosis ,Germany ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Tuberculosis, Pulmonary ,Aged ,GeneXpert MTB/RIF ,medicine.diagnostic_test ,Diagnostic Tests, Routine ,business.industry ,Incidence (epidemiology) ,ELISPOT ,Sputum ,Mycobacterium tuberculosis ,Middle Aged ,medicine.disease ,respiratory tract diseases ,Bronchoalveolar lavage ,030228 respiratory system ,Female ,medicine.symptom ,business ,Bronchoalveolar Lavage Fluid - Abstract
Diagnosing pulmonary tuberculosis (TB) may be delayed until culture results become available.We ascertained the accuracy of a stepwise diagnostic algorithm for the rapid diagnosis of pulmonary TB by GeneXpert from sputum and/or bronchoalveolar lavage (BAL) followed by aMycobacterium tuberculosis-specific BAL ELISPOT assay in patients with a suspected diagnosis of pulmonary TB at a clinical referral centre in Germany.Among 166 patients with a presumptive diagnosis of pulmonary TB, 81 cases were confirmed byM. tuberculosisculture from sputum and/or BAL. In 66 out of 81 (81.5%) cases, patients initially hadM. tuberculosisdetected by GeneXpert from sputum; in addition, six out of 81 (7.4%) cases were diagnosed by GeneXpert on BAL fluid (together 72 out of 81 (88.9%) patients). Out of the remaining nine patients with negative GeneXpert results from sputum and BAL, BAL ELISPOT identified eight patients with culture-confirmed TB correctly (median time to culture positivity 26 days). At a cut-off of >4000 early secretory antigenic target-6- or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 000 0000 lymphocytes, the specificity of the BAL ELISPOT for active TB was 97%.In low TB incidence countries, nearly all patients with active pulmonary TB can be identified within the first few days of clinical presentation using a stepwise strategy with GeneXpert and BAL ELISPOT.
- Published
- 2018
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