Universidad Peruana Cayetano Heredia

Algorithm for the diagnosis of smear-negative pulmonary tuberculosis in high-incidence resource-constrained settings

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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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