The incremental value of bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in a high-burden urban setting - 01/06/19

Doi : 10.1016/j.jinf.2019.05.009

Ping Xu ^a,^b,^{^{1
These authors contributed equally to this work.}}, Peijun Tang ^c,^{^{1
These authors contributed equally to this work.}}, Huafeng Song ^a,^b,^{^{1
These authors contributed equally to this work.}}, Jing Zhao ^a,^b, Hui Chen ^a,^b, Jing Xue ^a,^b, Yunxia Zhai ^a,^b, Yu Pang ^a,^d,^⁎ , Meiying Wu ^a,^b,^c,^⁎
^a Department of Clinical Laboratory, The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, No. 10, Guangqian Road, Xiangcheng District, Suzhou 215000, China
^b The Key Laboratory of Infection and Immunity of Suzhou City, Suzhou, China
^c Department of Tuberculosis, The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
^d National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing 101149, China

^⁎Corresponding author at: National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing 101149, China.National Clinical Laboratory on TuberculosisBeijing Chest Hospital affiliated to Capital Medical UniversityBeijing Tuberculosis and Thoracic Tumor Research InstituteNo 9, Beiguan Street, Tongzhou DistrictBeijing101149China^⁎⁎Corresponding author at: Department of Clinical Laboratory, The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, No. 10, Guangqian Road, Xiangcheng District, Suzhou 215000, ChinaDepartment of Clinical LaboratoryThe Fifth People's Hospital of SuzhouInfectious Disease Hospital Affiliated to Soochow UniversityNo. 10, Guangqian Road, Xiangcheng DistrictSuzhou215000China

Summary

Objectives

We prospectively evaluated the use of bronchoalveolar lavage fluid (BALF) specimens to assess their added incremental value to pulmonary tuberculosis (TB) diagnostic strategies used currently in a high-burden urban setting in China.

Methods

A prospective study was conducted of patients with presumptive pulmonary TB registered at the Fifth Hospital of Suzhou between March 2018 and July 2018. BALF samples from patients with initial Xpert-negative sputum results were tested to diagnose TB.

Results

Of 440 participants, 316 (71.8%) were initially diagnosed with TB from sputum, including 245 (55.7%) definitive TB cases based on a positive culture and/or Xpert result(s) and 71 (16.1%) positive cases based on clinical diagnosis. Of 153 patients with initial positive cultures, a significantly higher proportion were confirmed as TB-positive using Xpert (94.1%) versus smear microscopy (45.8%, P < 0.01). Xpert testing of BALF from 182 Xpert-negative cases exhibited greater detection sensitivity (97.4%) than did smear microscopy (23.4%, P < 0.01). Meanwhile, 74.1% of TB patients initially diagnosed as TB-negative via smear microscopy were identified using Xpert testing of BALF at reduced diagnostic cost/patient (from USD 266.9 to 171.5).

Conclusions

BALF samples added incremental value to pulmonary TB diagnostic strategies for patients with Xpert-negative sputum. Xpert outperformed smear microscopy for tubercle bacilli detection in both sputum and BALF.

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Keywords : Tuberculosis, Bronchoalveolar lavage, Xpert, Smear microscopy, Cost analysis

Plan

Introduction

Materials and methods

Diagnostic accuracy of Xpert and smear microscopy performed on sputum specimens

Diagnostic accuracy of Xpert and smear microscopy performed on BALF specimens

Cost analysis

Discussion

Conflict of Interest

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Vol 79 - N° 1

P. 24-29 - juillet 2019 Retour au numéro

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The incremental value of bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in a high-burden urban setting - 01/06/19

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