Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan
To determine association of clinico-radiological factors and radiological activity with diagnostic yield in sputum-smear negative tuberculosis (TB). Prospective observational study in Military Hospital Rawalpindi from July to December 2018. Adult patients having no contraindications to bronchoscopy...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2021-12-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/index.php/macd/article/view/1976 |
| _version_ | 1818405871248474112 |
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| author | Taymmia Ejaz Mahmood Iqbal Malik Jamal Ahmed Rizwan Azam Yousaf Jamal Sheema Saadia |
| author_facet | Taymmia Ejaz Mahmood Iqbal Malik Jamal Ahmed Rizwan Azam Yousaf Jamal Sheema Saadia |
| author_sort | Taymmia Ejaz |
| collection | DOAJ |
| description | To determine association of clinico-radiological factors and radiological activity with diagnostic yield in sputum-smear negative tuberculosis (TB). Prospective observational study in Military Hospital Rawalpindi from July to December 2018. Adult patients having no contraindications to bronchoscopy were included. HIV positive patients and those on anti-tuberculosis therapy for more than one week were excluded. High-Resolution Computed tomography (HRCT) findings were classified based on active and inactive tuberculosis features. Washings were sent for Acid-Fast Bacillus (AFB) smear, GeneXpert assay and cultures. Out of 215 patients, 42.3% (91) were diagnosed with microbiological or histological evidence of TB. On univariate analysis, cavitation (p-value <0.001), soft-tissue nodules (p-value 0.04), and endobronchial mucosal changes (p-value 0.02) were associated with culture positivity. Presence of cavitation (OR= 4.10; CI= 2.18,7.73; p-value<0.001) was the only independent predictor of microbiological yield. Diagnostic yield was 70%, 50%, 12.5% and 8.6% in patients with definitely active, probably active, indeterminate and inactive tuberculosis HRCT features respectively. Sensitivity, specificity, positive predictive value and negative predictive value of HRCT active TB were 95.38% (95% CI 87.10 -99.04), 48.00 % (95% CI 39.78 -56.30), 44.29% (95% CI 40.31 -48.33), 96.00 % (95%CI 88.70 -98.66) respectively. There was no significant association between age groups, smoking status and gender with diagnosis of tuberculosis in our study. Radiological activity and certain visualized bronchoscopic changes were associated with good diagnostic performance and can be used as predictive factors in diagnosis of active smear negative tuberculosis. |
| first_indexed | 2024-12-14T09:02:56Z |
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| id | doaj.art-ec61202e5c234b6893938384aeaa295c |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-12-14T09:02:56Z |
| publishDate | 2021-12-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-ec61202e5c234b6893938384aeaa295c2022-12-21T23:08:46ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642021-12-0110.4081/monaldi.2021.1976Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in PakistanTaymmia Ejaz0Mahmood Iqbal Malik1Jamal Ahmed2Rizwan Azam3Yousaf Jamal4Sheema Saadia5Department of Medicine, Aga Khan University Hospital, KarachiDepartment of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, RawalpindiDepartment of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, RawalpindiDepartment of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, RawalpindiDepartment of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, RawalpindiDepartment of Medicine, Aga Khan University Hospital, KarachiTo determine association of clinico-radiological factors and radiological activity with diagnostic yield in sputum-smear negative tuberculosis (TB). Prospective observational study in Military Hospital Rawalpindi from July to December 2018. Adult patients having no contraindications to bronchoscopy were included. HIV positive patients and those on anti-tuberculosis therapy for more than one week were excluded. High-Resolution Computed tomography (HRCT) findings were classified based on active and inactive tuberculosis features. Washings were sent for Acid-Fast Bacillus (AFB) smear, GeneXpert assay and cultures. Out of 215 patients, 42.3% (91) were diagnosed with microbiological or histological evidence of TB. On univariate analysis, cavitation (p-value <0.001), soft-tissue nodules (p-value 0.04), and endobronchial mucosal changes (p-value 0.02) were associated with culture positivity. Presence of cavitation (OR= 4.10; CI= 2.18,7.73; p-value<0.001) was the only independent predictor of microbiological yield. Diagnostic yield was 70%, 50%, 12.5% and 8.6% in patients with definitely active, probably active, indeterminate and inactive tuberculosis HRCT features respectively. Sensitivity, specificity, positive predictive value and negative predictive value of HRCT active TB were 95.38% (95% CI 87.10 -99.04), 48.00 % (95% CI 39.78 -56.30), 44.29% (95% CI 40.31 -48.33), 96.00 % (95%CI 88.70 -98.66) respectively. There was no significant association between age groups, smoking status and gender with diagnosis of tuberculosis in our study. Radiological activity and certain visualized bronchoscopic changes were associated with good diagnostic performance and can be used as predictive factors in diagnosis of active smear negative tuberculosis.https://www.monaldi-archives.org/index.php/macd/article/view/1976TuberculosisHRCTBronchoscopyGeneXpert |
| spellingShingle | Taymmia Ejaz Mahmood Iqbal Malik Jamal Ahmed Rizwan Azam Yousaf Jamal Sheema Saadia Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan Monaldi Archives for Chest Disease Tuberculosis HRCT Bronchoscopy GeneXpert |
| title | Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan |
| title_full | Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan |
| title_fullStr | Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan |
| title_full_unstemmed | Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan |
| title_short | Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan |
| title_sort | clinico radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in pakistan |
| topic | Tuberculosis HRCT Bronchoscopy GeneXpert |
| url | https://www.monaldi-archives.org/index.php/macd/article/view/1976 |
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