ArticlePloS one2014
A comparison of tools used for tuberculosis diagnosis in resource-limited settings: a case study at Mubende referral hospital, Uganda.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed, 13 citations in OpenAlex.
- Activation and proliferation profiles of M.tuberculosis specific dual functional CD4+T cells from smear negative pulmonary TB patients.PloS one · 2025Article
- Effect of mixed Mycobacterium tuberculosis infection on rapid molecular diagnostics among patients starting MDR-TB treatment in Uganda.BMC infectious diseases · 2024Article
- Effect of mixed Mycobacterium tuberculosis infection on rapid molecular diagnostics among patients starting MDR-TB treatment in Uganda.Research square · 2023Article
- Mycobacterium tuberculosis antigen-specific T-cell responses in smear-negative pulmonary tuberculosis patients.Clinical and experimental immunology · 2022Article
- "There are many fevers": Communities' perception and management of Febrile illness and its relationship with human animal interactions in South-Western Uganda.PLoS neglected tropical diseases · 2022Article
- The Epidemiology of Zoonotic Brucellosis in Bahr el Ghazal Region of South Sudan.Frontiers in public health · 2019Article
- Dynamics of tuberculosis in Wau, South Sudan during a period of armed conflict.Journal of clinical tuberculosis and other mycobacterial diseases · 2018Article
- Diagnosis of mycobacterial infections based on acid-fast bacilli test and bacterial growth time and implications on treatment and disease outcome.BMC infectious diseases · 2016Article
- Map the gap: missing children with drug-resistant tuberculosis.Public health action · 2015Article
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Authors and funding
6 authors at 5 institutions in 5 countries.
Funding
Abstract
backgroundThis study compared TB diagnostic tools and estimated levels of misdiagnosis in a resource-limited setting. Furthermore, we estimated the diagnostic utility of three-TB-associated predictors in an algorithm with and without Direct Ziehl-Neelsen (DZM). MATERIALS AND
methodsData was obtained from a cross-sectional study in 2011 conducted at Mubende regional referral hospital in Uganda. An individual was included if they presented with a two weeks persistent cough and or lymphadenitis/abscess. 344 samples were analyzed on DZM in Mubende and compared to duplicates analyzed on direct fluorescent microscopy (DFM), growth on solid and liquid media at Makerere University. Clinical variables from a questionnaire and DZM were used to predict TB status in multivariable logistic and Cox proportional hazard models, while optimization and visualization was done with receiver operating characteristics curve and algorithm-charts in Stata, R and Lucid-Charts respectively.
resultsDZM had a sensitivity and specificity of 36.4% (95% CI = 24.9-49.1) and 97.1%(95% CI = 94.4-98.7) compared to DFM which had a sensitivity and specificity of 80.3%(95% CI = 68.7-89.1) and 97.1%(95% CI = 94.4-98.7) respectively. DZM false negative results were associated with patient's HIV status, tobacco smoking and extra-pulmonary tuberculosis. One of the false negative cases was infected with multi drug resistant TB (MDR). The three-predictor screening algorithm with and without DZM classified 50% and 33% of the true cases respectively, while the adjusted algorithm with DZM classified 78% of the true cases.
conclusionThe study supports the concern that using DZM alone risks missing majority of TB cases, in this case we found nearly 60%, of who one was an MDR case. Although adopting DFM would reduce this proportion to 19%, the use of a three-predictor screening algorithm together with DZM was almost as good as DFM alone. It's utility is whoever subject to HIV screening all TB suspects.
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