An early and trustable indicator suggestive of non-tuberculosis mycobacteria isolation in a high tuberculosis burden setting - 30/04/24
Summary |
Background |
Distinguishing between nontuberculous mycobacterial (NTM) lung infections and pulmonary tuberculosis becomes challenging due to their similar clinical manifestations and radiological images. Consequently, instances of delayed diagnosis or misdiagnosis are highly frequent. A feasible and reliable indicator of the existence of NTM in the early stages of the disease would help to solve this dilemma.
Methods |
In this study, we evaluated the potential of smear-positive and Xpert assay (Cepheid, USA) negative outcomes as an early indicator of possible NTM infection in a high TB-burden setting retrospectively and prospectively.
Results |
During the study period, 12·77% (138/1081) of the smear-positive cases yielded negative outcomes with the simultaneous Xpert assay. From the 110 patients who yielded smear-positive/Xpert-negative outcomes and cultivated strain as well, 105 (95·45%) were proved to have NTM isolated. By incorporating an additional criterion of a negative result from the Interferon-gamma release assay, the accuracy of the screening method reached 100%. Regarding the NTM presence prediction value, smear-positive/Xpert-negative has a sensitivity of 24·86% (45/181) in all NTM isolated cases but 93·75–96·55% accuracy in retrospective study or 93·75% accuracy in prospective study in smear-positive NTM isolated cases. In addition, the specificity was ∼99·47% (943/948) in smear-positive tuberculosis cases.
Conclusion |
The clue of the presence of NTM could be obtained on the first day of the hospital visit due to the point of care (POC) feature of smear testing and Xpert assay. About one-fourth of the NTM-isolated patients would benefit from this rapid, convenient, and reliable screening strategy in the given circumstance. Smear-positive/Xpert-negative outcome is an early, trustable indicator that is indicative of NTM isolation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Smear-positive/Xpert-negative outcomes could timely predict the NTM presence. |
• | The clue of the presence of NTM could be obtained on the first day of a hospital visit. |
• | The examination outcome could retrieved from a routine laboratory workout. |
• | Many patients would benefit from this rapid, convenient, and reliable screening strategy. |
Keywords : Tuberculosis, Nontuberculous mycobacteria, Differential diagnosis, Indicator
Plan
Vol 88 - N° 5
Article 106149- mai 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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