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Medicina & Laboratorio

2017, Number 09-10

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Medicina & Laboratorio 2017; 23 (09-10)

Diagnosis of pulmonary tuberculosis in bronchoalveolar lavage: performance of PCR compared to routine microbiological tests

Rincón-Caballero OL, Cano-Romero MA, Aristizábal-Bernal BH

Language: Spanish
References: 43
Page: 475-484
PDF size: 386.40 Kb.


ABSTRACT

Introduction: in patients with a high clinical suspicion, radiological alterations and respiratory symptoms compatible with pulmonary tuberculosis it is recommended to obtain samples of bronchoalveolar lavage to improve the diagnostic sensitivity of the test used. Objective: To describe the performance of polymerase chain reaction (PCR) for Mycobacterium tuberculosis detection in bronchoalveolar lavage samples in suspected cases of pulmonary tuberculosis. Material and methods: A retrospective analytical study of 611 bronchoalveolar lavage samples from 606 patients with suspected pulmonary tuberculosis who attended in Hospital Pablo Tobon Uribe (Colombia) between 2005 and 2015 was performed. Sensitivity, specificity and positive and negative predictive values of polymerase chain reaction were calculated by comparison with the culture (gold standard). Results: From the total of analyzed samples 4.9% were positive for Mycobacterium tuberculosis by polymerase chain reaction positive and 3.9% by culture. Of the polymerase chain reaction positive samples, 80% (24/30) were positive on the culture. The sensitivity, specificity, negative and positive predictive values of polymerase chain reaction for Mycobacterium tuberculosis in bronchoalveolar lavage samples were 100%, 99.0%, 100%, 80.0%, respectively. Conclusion: Polymerase chain reaction for the detection of Mycobacterium tuberculosis in bronchoalveolar lavage samples is superior in time, sensitivity and specificity, than the smear and culture, proving to be effective, together with the clinical data, to make a rapid diagnostic approach.


REFERENCES

  1. World Health Organization. Guidelines on the management of latent tuberculosis infection. Ginebra, Suiza: WHO Press; 2015.

  2. Organización Mundial de la Salud. Tuberculosis. Nota descriptiva. 2017. Disponible: http://www. who.int/mediacentre/factsheets/fs104/es/. Consultado: oct 2017.

  3. República de Colombia, Ministerio de la Protección Social, Instituto Nacional de Salud, Organización Panamericana de la Salud. Plan Estratégico: Colombia Libre de Tuberculosis 2010- 2015. Para la Expansión y Fortalecimiento de la Estrategia Alto a la TB. 2009. Disponible: http:// www.paho.org/col/index.php?option=com_ d ocman & view=down load & category_slug=publicaciones-ops-oms-colombia&alias=327-plan-estrategico-colombia-libre-de-tuberculosis- 2010-2015&Itemid=688. Consultado: oct 2017.

  4. Organización Mundial de la Salud. Informe mundial sobre la tuberculosis 2016. 2016. Disponible: http://www.who.int/tb/publications/ global_report/gtbr2016_executive_summary_ es.pdf?ua=1. Consultado: oct 2017.

  5. Tripathy S, Kumar R, Singh SD. Prevalence of multidrug resistant pulmonary tuberculosis in North Bihar. J Clin Diagn Res 2015; 9: LC09-LC12.

  6. Theegarten D, Totsch M, Worm K, Darwiche K, Anhenn O, Wohlschlager J. [Diagnosis of pulmonary tuberculosis using Ziehl-Neelsen stain and polymerase chain reaction]. Pathologe 2013; 34: 305-309.

  7. Selman B C, Poggi M H, Román JC, García C P, Lagos L M. Análisis retrospectivo del rendimiento de Amplicor-PCR® para la detección de Mycobacterium tuberculosis en muestras respiratorias y no respiratorias con baciloscopia negativa. Rev Chil Infecto 2009; 26: 495-498.

  8. Gholoobi A, Masoudi-Kazemabad A, Meshkat M, Meshkat Z. Comparison of Culture and PCR Methods for Diagnosis of Mycobacterium tuberculosis in Different Clinical Specimens. Jundishapur J Microbiol 2014; 7: e8939.

  9. Bajrami R, Mulliqi G, Kurti A, Lila G, Raka L. Comparison of GeneXpert MTB/RIF and conventional methods for the diagnosis of tuberculosis in Kosovo. J Infect Dev Ctries 2016; 10: 418-422.

  10. Chida N, Shah M. Infectious Diseases (ID) Learn ing Unit: How Rapidly to Evaluate for Active Tuberculosis Disease in Low-Prevalence Settings. Open Forum Infect Dis 2016; 3: 1-4.

  11. Le Palud P, Cattoir V, Malbruny B, Magnier R, Campbell K, Oulkhouir Y, et al. Retrospective observational study of diagnostic accuracy of the Xpert® MTB/RIF assay on fiberoptic bronchoscopy sampling for early diagnosis of smear-negative or sputum-scarce patients with suspected tuberculosis. BMC Pulm Med 2014; 14: 137-137.

  12. Peña C, Césped M, Wolff M, Álvarez F, Garay C, Medina M, et al. Diagnóstico bacteriológico de tuberculosis pulmonar mediante fibrobroncoscopía en pacientes con VIH. Rev Chil Enf Respir 2014; 30 46-53.

  13. Baro A, Shah I, Chandane P, Khosla I. Pulmonary alveolar proteinosis in a 10-year-old girl masquerading as tuberculosis. Oxf Med Case Reports 2015; 2015: 300-302.

  14. Martins Soares V, Da Silva Carvalho W, Spindola De Miranda S. Utilization of bacteriological culture for increased diagnostic performance at a tuberculosis reference center hospital. Rev Argent Microbiol 2012; 44: 173-176.

  15. Gobierno de Chile, Ministerio de Salud, Instituto de Salud Pública. Manual Bacteriología TBC: Diagnóstico de tuberculosis. 2010. Disponible: http://www.ispch.cl/sites/default/ f i les/documento/2010/05/Manua l%20 bacteriolog%C3%ADa%20TBC.pdf. Consultado: oct 2017.

  16. 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 2014: 1-166.

  17. Park JS. Issues Related to the Updated 2014 Korean Guidelines for Tuberculosis. Tuberc Respir Dis 2016; 79: 1-4.

  18. Ortiz-Marín DC, Aristizábal BH. Métodos diagnósticos moleculares en tuberculosis. Medicina UPB 2013; 32 144-150.

  19. D’Alessandro A, de Waard JH. Evaluación de dos pruebas comerciales para el serodiagnóstico de la tuberculosis pulmonar. Rev Chil Infectol 2008; 25: 37-40.

  20. Osman AL, Saeed NS, Elhassan MM. Polymerase Chain Reaction targeting insertion sequence IS6110 for the diagnosis of pulmonary tuberculosis among Sudanese children and young adults. Int J Mycobacteriol 2014; 3: 252-258.

  21. Raveendran R, Wattal C. Utility of multiplex real- time PCR in the diagnosis of extrapulmonary tuberculosis. Braz J Infect Dis 2016; 20: 235-241.

  22. Olsen SR, Long R, Tyrrell G, Kunimoto D. Induced sputum for the diagnosis of pulmonary tuberculosis: Is it useful in clinical practice? Can Respir J 2010; 17: e81-84.

  23. Mohan A, Sharma SK. Fibreoptic bronchoscopy in the diagnosis of sputum smear-negative pulmonary tuberculosis: current status. Indian J Chest Dis Allied Sci 2008; 50: 67-78.

  24. Centers for Disease Control and Prevention. Updated Guidelines for the Use of Nucleic Acid Amplification Tests in the Diagnosis of Tuberculosis. MMWR 2009; 58 7-10.

  25. Nava-Paz O, Hassanhi M, Prieto L. Evaluación de la baciloscopia, cultivo y reacción en cadena de la polimerasa para el diagnóstico de tuberculosis pulmonar. Kasmera 2005; 33: 119-131.

  26. Moore DF, Guzman JA, Mikhail LT. Reduction in turnaround time for laboratory diagnosis of pulmonary tuberculosis by routine use of a nucleic acid amplification test. Diagn Microbiol Infect Dis 2005; 52: 247-254.

  27. Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess 2007; 11: 1-196.

  28. Chagas M, Maurici R, Bazzo ML, dos Santos JI. The use of polymerase chain reaction for early diagnosis of tuberculosis in Mycobacterium tuberculosis culture. Braz J Med Biol Res 2010; 43: 543-548.

  29. Manosuthi W, Wiboonchutikul S, Sungkanuparph S. Integrated therapy for HIV and tuberculosis. AIDS Res Ther 2016; 13: 22.

  30. Chihota VN, Grant AD, Fielding K, Ndibongo B, van Zyl A, Muirhead D, et al. Liquid vs. solid culture for tuberculosis: performance and cost in a resource-constrained setting. Int J Tuberc Lung Dis 2010; 14: 1024-1031.

  31. Schumacher SG, Sohn H, Qin ZZ, Gore G, Davis JL, Denkinger CM, et al. Impact of Molecular Diagnostics for Tuberculosis on Patient-Important Outcomes: A Systematic Review of Study Methodologies. PLoS One 2016; 11: e0151073.

  32. Ryu YJ. Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms. Tuberc Respir Dis (Seoul) 2015; 78: 64-71.

  33. Cheng VC, Yew WW, Yuen KY. Molecular diagnostics in tuberculosis. Eur J Clin Microbiol Infect Dis 2005; 24: 711-720.

  34. Campos M, Quartin A, Mendes E, Abreu A, Gurevich S, Echarte L, et al. Feasibility of shortening respiratory isolation with a single sputum nucleic acid amplification test. Am J Respir Crit Care Med 2008; 178: 300-305.

  35. Conaty SJ, Claxton AP, Enoch DA, Hayward AC, Lipman MC, Gillespie SH. The interpretation of nucleic acid amplification tests for tuberculosis: do rapid tests change treatment decisions? J Infect 2005; 50: 187-192.

  36. Chaisson LH, Roemer M, Cantu D, Haller B, Millman AJ, Cattamanchi A, et al. Impact of GeneXpert MTB/RIF assay on triage of respiratory isolation rooms for inpatients with presumed tuberculosis: a hypothetical trial. Clin Infect Dis 2014; 59: 1353-1360.

  37. Lyra JM, Maruza M, Verza M, Carneiro MM, Albuquerque Mde F, Rossetti ML, et al. Evaluation of four molecular methods for the diagnosis of tuberculosis in pulmonary and blood samples from immunocompromised patients. Mem Inst Oswaldo Cruz 2014; 109: 805-813.

  38. Lee SH, Kim SW, Lee S, Kim E, Kim DJ, Park S, et al. Rapid detection of Mycobacterium tuberculosis using a novel ultrafast chip-type real-time polymerase chain reaction system. Chest 2014; 146: 1319-1326.

  39. Agudelo CA, Builes LN, Hernández M, Robledo J. Nuevos métodos para el diagnóstico de la tuberculosis. Iatreia 2008; 21: 321-332.

  40. Theron G, Peter J, Calligaro G, Meldau R, Hanrahan C, Khalfey H, et al. Determinants of PCR performance (Xpert MTB/RIF), including bacterial load and inhibition, for TB diagnosis using specimens from different body compartments. Sci Rep 2014; 4: 5658.

  41. Kulkarni S, Singh P, Memon A, Nataraj G, Kanade S, Kelkar R, et al. An in-house multiplex PCR test for the detection of Mycobacterium tuberculosis, its validation & comparison with a single target TB-PCR kit. Indian J Med Res 2012; 135: 788-794.

  42. Schluger NW. Changing approaches to the diagnosis of tuberculosis. Am J Respir Crit Care Med 2001; 164: 2020-2024.

  43. Nikbakhsh N, Bayani M, Siadati S. The Value of Bronchoalveolar Lavage in the Diagnosis of Sputum Smear-NegativePulmonary Tuberculosis. Iran J Pathol 2015; 10: 35-40.




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