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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 |
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