ArticlePloS one2011
Nucleic acid amplification tests for diagnosis of smear-negative TB in a high HIV-prevalence setting: a prospective cohort study.
Article in PloS one, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 34 citations in OpenAlex.
- A Comprehensive Review of HIV-Associated Tuberculosis: Clinical Challenges and Advances in Management.Cureus · 2024Review
- A descriptive study of smear negative pulmonary tuberculosis in a high HIV burden patient's population in North Central Nigeria.PloS one · 2020Article
- A Clinical TB Detection Method Based on Molecular Typing Technique with Quality Control.Computational and mathematical methods in medicine · 2019Article
- Mycobacteriosis and Tuberculosis: Laboratory Diagnosis.The open microbiology journal · 2018Review
- Biographical Feature: Patrick R. Murray, Ph.D.Journal of clinical microbiology · 2016Article
- Tuberculous Pleural Effusion.Turkish thoracic journal · 2015Review
- Evaluation of four molecular methods for the diagnosis of tuberculosis in pulmonary and blood samples from immunocompromised patients.Memorias do Instituto Oswaldo Cruz · 2014Article
- Procalcitonin predicts mortality in HIV-infected Ugandan adults with lower respiratory tract infections.Respirology (Carlton, Vic.) · 2014Article
- A tale of two specificities: bispecific antibodies for therapeutic and diagnostic applications.Trends in biotechnology · 2013Review
- Article
- Early and efficient detection of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures.PloS one · 2013Article
- High-throughput sequencing enhanced phage display identifies peptides that bind mycobacteria.PloS one · 2013Article
- Novel real-time simultaneous amplification and testing method to accurately and rapidly detect Mycobacterium tuberculosis complex.Journal of clinical microbiology · 2012Article
- Performance of Clinical Algorithms for Smear-Negative Tuberculosis in HIV-Infected Persons in Ho Chi Minh City, Vietnam.Tuberculosis research and treatment · 2012Article
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundNucleic acid amplification tests are sensitive for identifying Mycobacterium tuberculosis in populations with positive sputum smears for acid-fast bacilli, but less sensitive in sputum-smear-negative populations. Few studies have evaluated the clinical impact of these tests in low-income countries with high burdens of TB and HIV.
methodsWe prospectively enrolled 211 consecutive adults with cough ≥2 weeks and negative sputum smears at Mulago Hospital in Kampala, Uganda. We tested a single early-morning sputum specimen for Mycobacterium tuberculosis DNA using two nucleic acid amplification tests: a novel in-house polymerase chain reaction targeting the mycobacterial secA1 gene, and the commercial Amplified® Mycobacterium tuberculosis Direct (MTD) test (Gen-Probe Inc, San Diego, CA). We calculated the diagnostic accuracy of these index tests in reference to a primary microbiologic gold standard (positive mycobacterial culture of sputum or bronchoalveolar lavage fluid), and measured their likely clinical impact on additional tuberculosis cases detected among those not prescribed initial TB treatment.
resultsOf 211 patients enrolled, 170 (81%) were HIV-seropositive, with median CD4+ T-cell count 78 cells/µL (interquartile range 29-203). Among HIV-seropositive patients, 94 (55%) reported taking co-trimoxazole prophylaxis and 29 (17%) reported taking antiretroviral therapy. Seventy-five patients (36%) had culture-confirmed TB. Sensitivity of MTD was 39% (95% CI 28-51) and that of secA1 was 24% (95% CI 15-35). Both tests had specificities of 95% (95% CI 90-98). The MTD test correctly identified 18 (24%) TB patients not treated at discharge and led to a 72% relative increase in the smear-negative case detection rate.
conclusionsThe secA1 and MTD nucleic acid amplification tests had moderate sensitivity and high specificity for TB in a predominantly HIV-seropositive population with negative sputum smears. Although newer, more sensitive nucleic acid assays may enhance detection of Mycobacterium tuberculosis in sputum, even currently available tests can provide substantial clinical impact in smear-negative populations.
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