dc.contributor.author |
Soto, Alonso |
|
dc.contributor.author |
Solari, Lely |
|
dc.contributor.author |
Agapito, Juan |
|
dc.contributor.author |
Gotuzzo Herencia, José Eduardo |
|
dc.contributor.author |
Accinelli Tanaka, Roberto Alfonso |
|
dc.contributor.author |
Vargas, Dante |
|
dc.contributor.author |
Acurio, Vilma |
|
dc.contributor.author |
Matthys, Francine |
|
dc.contributor.author |
Van der Stuyft, Patrick |
|
dc.date.accessioned |
2022-01-04T20:33:21Z |
|
dc.date.available |
2022-01-04T20:33:21Z |
|
dc.date.issued |
2013 |
|
dc.identifier.uri |
https://hdl.handle.net/20.500.12866/10786 |
|
dc.description.abstract |
Objectives: Diagnosis of smear-negative pulmonary tuberculosis (SNPT) remains a challenge, particularly in resource-constrained settings. We evaluated a diagnostic algorithm that combines affordable laboratory tools and a clinical prediction rule (CPR). Methods: We derived, based on published evidence, a diagnostic algorithm for SNPT. Sputum concentration constitutes its first step. In suspects with negative results, SNPT probability is classified with a CPR as low (excluded), high (confirmed) or intermediate. For intermediate patients, sputum Middlebrook 7H9 liquid culture is performed, and they are assessed after 2 weeks. If clinically deteriorated, with still negative liquid culture, bronchoscopy is offered. Otherwise, results of Middlebrook 7H9 culture are awaited. We prospectively evaluated this algorithm against a reference standard of solid and liquid cultures in two reference hospitals in Lima, Peru. Results: 670 SNPT suspects were included from September 2005 to March 2008. The prevalence of SNPT was 27% according to the reference standard. The algorithm's overall accuracy was 0.94 (95% CI 0.91–0.95), its sensitivity was 0.88 (95% CI 0.82–0.92) and its specificity, 0.96 (95% CI 0.94–0.98). Sputum concentration, the CPR, Middlebrook 7H9 sputum culture and bronchoscopic samples defined a diagnosis of SNPT according to the algorithm in 57 (37%), 25 (16%), 63 (41%) and 8(5%) of patients, respectively. 65% of patients were diagnosed within 3 weeks. Conclusions: The algorithm was accurate for SNPT diagnosis. Sputum concentration, CPR and selective Middlebrook 7H9 culture are essential components. |
en_US |
dc.language.iso |
eng |
|
dc.publisher |
Wiley |
|
dc.relation.ispartofseries |
Tropical Medicine and International Health |
|
dc.rights |
info:eu-repo/semantics/restrictedAccess |
|
dc.rights.uri |
https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es |
|
dc.subject |
Diagnosis |
en_US |
dc.subject |
Smear-negative |
en_US |
dc.subject |
tuberculosis |
en_US |
dc.subject |
pulmonary |
en_US |
dc.subject |
algorithms |
en_US |
dc.subject |
decision-making |
en_US |
dc.title |
Algorithm for the diagnosis of smear-negative pulmonary tuberculosis in high-incidence resource-constrained settings |
en_US |
dc.type |
info:eu-repo/semantics/article |
|
dc.identifier.doi |
https://doi.org/10.1111/tmi.12172 |
|
dc.subject.ocde |
https://purl.org/pe-repo/ocde/ford#3.03.06 |
|
dc.relation.issn |
1365-3156 |
|