Systematic screening for tuberculosis among hospital outpatients in Cameroon: The role of screening and testing algorithms to improve case detection.
Case detection
Chest X-ray
HIV/AIDS
Molecular diagnostics
Tuberculosis
Journal
Journal of clinical tuberculosis and other mycobacterial diseases
ISSN: 2405-5794
Titre abrégé: J Clin Tuberc Other Mycobact Dis
Pays: England
ID NLM: 101682877
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
entrez:
14
11
2019
pubmed:
14
11
2019
medline:
14
11
2019
Statut:
epublish
Résumé
Better screening and testing approaches are needed to improve TB case finding, particularly in health facilities where many people with TB seek care but are not diagnosed using the existing approaches. We aimed to evaluate the performance of various TB screening and testing approaches among hospital outpatients in a setting with a high prevalence of HIV/TB. We screened outpatients at a large hospital in Cameroon using both chest X-ray and a symptom questionnaire including current cough, fever, night sweats and/or weight loss. Participants with a positive screen were tested for TB using smear microscopy, the Xpert MTB/RIF assay, and culture. Among 2051 people screened, 1137 (55%) reported one or more TB symptom and 389 (19%) had an abnormal chest X-ray. In total, 1255 people (61%) had a positive screen and 31 of those screened (1.5%) had bacteriologically confirmed TB. To detect TB, screening with cough >2 weeks had a sensitivity of 61% (95% CI, 44-78%). Screening for a combination of cough >2 -weeks and/or abnormal chest X-ray had a sensitivity of 81% (95% CI, 67-95%) and specificity of 71% (95% CI, 69-73%), while screening for a combination of cough >2 weeks or any of 2 or more symptoms had a similar performance. Smear microscopy and Xpert MTB/RIF detected 32% (10/31) and 55% (17/31), respectively, of people who had bacteriologically-confirmed TB. Screening hospital outpatients for cough >2 weeks or for at least 2 of current cough, fever, night sweats or weight loss is a feasible strategy that had a high relative yield to detect bacteriologically-confirmed TB in this population. Clinical diagnosis of TB is still an important need, even where Xpert MTB/RIF testing is available.
Sections du résumé
BACKGROUND
BACKGROUND
Better screening and testing approaches are needed to improve TB case finding, particularly in health facilities where many people with TB seek care but are not diagnosed using the existing approaches.
OBJECTIVE
OBJECTIVE
We aimed to evaluate the performance of various TB screening and testing approaches among hospital outpatients in a setting with a high prevalence of HIV/TB.
METHODS
METHODS
We screened outpatients at a large hospital in Cameroon using both chest X-ray and a symptom questionnaire including current cough, fever, night sweats and/or weight loss. Participants with a positive screen were tested for TB using smear microscopy, the Xpert MTB/RIF assay, and culture.
RESULTS
RESULTS
Among 2051 people screened, 1137 (55%) reported one or more TB symptom and 389 (19%) had an abnormal chest X-ray. In total, 1255 people (61%) had a positive screen and 31 of those screened (1.5%) had bacteriologically confirmed TB. To detect TB, screening with cough >2 weeks had a sensitivity of 61% (95% CI, 44-78%). Screening for a combination of cough >2 -weeks and/or abnormal chest X-ray had a sensitivity of 81% (95% CI, 67-95%) and specificity of 71% (95% CI, 69-73%), while screening for a combination of cough >2 weeks or any of 2 or more symptoms had a similar performance. Smear microscopy and Xpert MTB/RIF detected 32% (10/31) and 55% (17/31), respectively, of people who had bacteriologically-confirmed TB.
CONCLUSIONS
CONCLUSIONS
Screening hospital outpatients for cough >2 weeks or for at least 2 of current cough, fever, night sweats or weight loss is a feasible strategy that had a high relative yield to detect bacteriologically-confirmed TB in this population. Clinical diagnosis of TB is still an important need, even where Xpert MTB/RIF testing is available.
Identifiants
pubmed: 31720422
doi: 10.1016/j.jctube.2019.100095
pii: S2405-5794(18)30046-9
pii: 100095
pmc: PMC6830146
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100095Informations de copyright
© 2019 Published by Elsevier Ltd.
Références
Chest. 2018 Feb;153(2):467-497
pubmed: 29196066
Int J Tuberc Lung Dis. 2014 Oct;18(10):1243-4
pubmed: 25216840
Eur Respir J. 2017 May 21;49(5):
pubmed: 28529202
Int J Tuberc Lung Dis. 2008 Jul;12(7):792-8
pubmed: 18544206
PLoS One. 2014 Apr 10;9(4):e94465
pubmed: 24722399
BMC Infect Dis. 2014 Oct 19;14:532
pubmed: 25326816
Int J Tuberc Lung Dis. 2006 Aug;10(8):876-82
pubmed: 16898372
Am J Respir Crit Care Med. 2013 Mar 1;187(5):543-51
pubmed: 23262515
Lancet Infect Dis. 2015 May;15(5):544-51
pubmed: 25765217
Lancet Infect Dis. 2006 Oct;6(10):664-74
pubmed: 17008175
PLoS Med. 2007 Oct 16;4(10):e297
pubmed: 17941715
Int J Tuberc Lung Dis. 2015 May;19(5):545-51
pubmed: 25868022
Clin Infect Dis. 2012 Nov;55(9):1171-8
pubmed: 22806590
Eur Respir J. 2015 Dec;46(6):1816-9
pubmed: 26405288
Int J Tuberc Lung Dis. 2013 Sep;17(9):1125-38
pubmed: 23928165
Int J Tuberc Lung Dis. 2012 Jun;16(6):762-7
pubmed: 22507287
PLoS Med. 2011 Jan 18;8(1):e1000391
pubmed: 21267059
Am J Respir Crit Care Med. 2011 May 1;183(9):1245-53
pubmed: 21239690
PLoS One. 2018 Jun 26;13(6):e0199634
pubmed: 29944701
PLoS One. 2015 Sep 18;10(9):e0138149
pubmed: 26383102
Trop Med Int Health. 2015 Sep;20(9):1128-1145
pubmed: 25943163
Eur Respir J. 2016 Aug;48(2):516-25
pubmed: 27418550
BMC Infect Dis. 2014 Jan 02;14:2
pubmed: 24383553
Int J Tuberc Lung Dis. 2016 Aug;20(8):1033-9
pubmed: 27393536
Int J Tuberc Lung Dis. 2016 Feb;20(2):211-7
pubmed: 26792473
Int J Tuberc Lung Dis. 2013 May;17(5):608-14
pubmed: 23575325
Int J Tuberc Lung Dis. 2013 Jul;17(7):856-65
pubmed: 23743306
Clin Infect Dis. 2014 Apr;58(7):970-6
pubmed: 24429440
Lancet Infect Dis. 2018 Jan;18(1):76-84
pubmed: 29198911
PLoS Med. 2011 Jul;8(7):e1001067
pubmed: 21818180
Emerg Infect Dis. 2016 Mar;22(3):535-7
pubmed: 26891185
Cochrane Database Syst Rev. 2022 Mar 23;3:CD010890
pubmed: 35320584
PLoS One. 2017 Mar 3;12(3):e0172881
pubmed: 28257424
Clin Infect Dis. 2012 Apr;54(8):1071-9
pubmed: 22318975
AIDS. 2010 Nov;24 Suppl 5:S19-27
pubmed: 21079424
Lancet. 2010 Oct 9;376(9748):1244-53
pubmed: 20923715