Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases


Autoři: Jovilia Abong aff001;  Victoria Dalay aff001;  Ivor Langley aff002;  Ewan Tomeny aff002;  Danaida Marcelo aff001;  Victor Mendoza aff001;  Arvin Christian Aquino aff001;  Anna Marie Celina Garfin aff003;  Bertie Squire aff002;  Charles Yu aff001
Působiště autorů: Research Division, De La Salle Medical and Health Sciences Institute, Dasmariñas City, Cavite, Philippines aff001;  Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom aff002;  National TB Control Program, Department of Health, Manila, Metro Manila, Philippines aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227093

Souhrn

Setting

A high proportion of notified tuberculosis cases in the Philippines are clinically diagnosed (63%) as opposed to bacteriologically confirmed. Better understanding of this phenomenon is required to improve tuberculosis control.

Objectives

To determine the percentage of smear negative presumptive tuberculosis patients that would be diagnosed by GeneXpert; compare clinical characteristics of patients diagnosed as tuberculosis cases; and review the impact that the current single government physician and a reconstituted Tuberculosis Diagnostic committee (expert panel) may have on tuberculosis over-diagnosis.

Design

This a cross-sectional study of 152 patients 15–85 years old with two negative Direct Sputum Smear Microscopy results, with abnormal chest X-ray who underwent GeneXpert testing and review by an expert panel.

Results

Thirty-two percent (48/152) of the sample were Xpert positive and 93% (97/104) of GeneXpert negatives were clinically diagnosed by a single physician. Typical symptoms and X-ray findings were higher in bacteriologically confirmed tuberculosis. When compared to the GeneXpert results the Expert panel’s sensitivity for active tuberculosis was high (97.5%, 39/40), specificity was low (40.2%, 35/87).

Conclusion

Using the GeneXpert would increase the level of bacteriologically confirmed tuberculosis substantially among presumptive tuberculosis. An expert panel will greatly reduce over-diagnosis usually seen when a decision is made by a single physician.

Klíčová slova:

Coughing – Diagnostic medicine – Medicine and health sciences – Philippines – Physicians – Sputum – Tuberculosis – Tuberculosis diagnosis and management


Zdroje

1. World Health Organization. Global Tuberculosis Report 2017: Leave no one behind—Unite to end TB [Internet]. WHO—Technical Report Series;727. GVA; 2017. Available from: http://www.who.int/tb/publications/global_report/gtbr2017_main_text.pdf?ua=1

2. World Health Organization. Tuberculosis Country Profile [Internet]. World Health Organization. GVA; 2019 [cited 2019 Sep 26]. p. 2019. Available from: https://www.who.int/tb/country/data/profiles/en/

3. Department of Health. Updates of TB Control Program in Calabarzon [Internet]. Manila; 2014. Available from: http://www.lcp.org.ph/UserFiles/League_of_Cities/file/sl-02.pdf

4. Department of Health. Integrated Tuberculosis Information System [Internet]. Department of Health. 2019. Available from: http://itis.org.ph/files/NTP/FHSIS_TB_2008.pdf

5. Department of Health. National TB Control Program: Manual of Procedures 5th Edition [Internet]. 5th ed. Manila: Department of Health—Disease Prevention and Control Bureau; 2014. 194 p. Available from: http://www.doh.gov.ph

6. Philippine Statistics Authority. 2018 Philippine Standard Geographic Code (PSGC). Philippine Statistics Authority. 2018.

7. Fraser RS, Muller NL, Colman N, Pare PD. Fraser and Paré’s Diagnosis of Diseases of the Chest. [Internet]. 4th ed. Philadelphia: Radiology Society of North America; 1999. Available from: https://pubs.rsna.org/doi/abs/10.1148/radiology.217.1.r00se51262?journalCode=radiology

8. Collins J, Stern EJ. Chest Radiology: The Essentials. 2nd Editio. Philadelphia: Lippincott Williams & Wilkins; 2007.

9. Corne J, Kumaran M. Chest X-Ray Made Easy [Internet]. 4th ed. Elsevier; 2015. Available from: https://www.elsevier.com/books/chest-x-ray-made-easy/corne/978-0-7020-5499-0

10. Shrestha P, Arjyal A, Caws M, Prajapati KG, Karkey A, Dongol S, et al. The Application of GeneXpert MTB/RIF for Smear-Negative TB Diagnosis as a Fee-Paying Service at a South Asian General Hospital. Tuberc Res Treat [Internet]. 2015;2015:1–6. Available from: https://www.hindawi.com/journals/trt/2015/102430/

11. Ko Y, Lee HY, Park YB, Hong SJ, Shin JH, Choi SJ, et al. Correlation of microbiological yield with radiographic activity on chest computed tomography in cases of suspected pulmonary tuberculosis. PLoS One [Internet]. 2018;13(8):1–13. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201748

12. Deependra Kumar R, Somesh T, Abhishek K, Chinki A, Asish K, Shyama K. Role of Gene-Xpert in Diagnosis of Smear Negative Pulmonary Tuberculosis. J Evol Med Dent Sci [Internet]. 2015;4(105):17034–7. Available from: https://www.researchgate.net/publication/305187058_ROLE_OF_GENE-XPERT_IN_DIAGNOSIS_OF_SMEAR_NEGATIVE_PULMONARY_TUBERCULOSIS

13. Lombardi G, Di Gregori V, Girometti N, Tadolini M, Bisognin F, Dal Monte P. Diagnosis of smear-negative tuberculosis is greatly improved by Xpert MTB/RIF. PLoS One [Internet]. 2017;12(4):1–10. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176186

14. Soto A, Solari L, Agapito J, Acuna-Villaorduna C, Lambert ML, Gotuzzo E, et al. Development of a clinical scoring system for the diagnosis of smear-negative pulmonary tuberculosis. Brazilian J Infect Dis [Internet]. 2008;12(2):128–32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18641849

15. Linguissi LSG, Vouvoungui CJ, Poulain P, Essassa GB, Kwedi S, Ntoumi F. Diagnosis of smear-negative pulmonary tuberculosis based on clinical signs in the Republic of Congo Infectious Diseases. BMC Res Notes [Internet]. 2015;8(1):1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684611/pdf/13104_2015_Article_1774.pdf

16. Sillano RMM, Kingkay CB, Morfe JHD. Turnaround Time for Smear-negative Category I Cases to Initiation of Treatment in District IV of Manila from January 2014 to December 2014. Philipp J Chest Dis [Internet]. 2017;18(2):9–13. Available from: http://philchest.org/v3/wp-content/uploads/2013/05/PJCD-vol-18-issue-2_final.pdf

17. Marcelo A, Fatmi Z, Firaza PN, Shaikh S, Dandan AJ, Irfan M, et al. An Online Method of Diagnosisof Difficult TB Cases for Developing Countries. IOS Press Ebooks [Internet]. 2011;168–73. Available from: http://ebooks.iospress.nl/publication/13892

18. Steingart KR, Schiller I, Horne DJ, Pai M, Boehme CC, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev [Internet]. 2014;2014(1). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009593.pub3/full

19. World Health Organization. Chest Radiography in Tuberculosis Detection—summary of current WHO recommendations and guidance on programmatic approaches [Internet]. WHO Library Cataloguing-in-Publication Data. Switzerland: WHO Press; 2016. 44 p. Available from: http://www.who.int/about/licensing/copyright_form%0Ahttp://www.who.int/about/licensing/copyright_form)


Článek vyšel v časopise

PLOS One


2019 Číslo 12