Early chest X-ray in persons with presumptive tuberculosis increases Xpert® MTB/RIF diagnostic yield and efficiency

Z Nadiah; R C Koesoemadinata; S M McAllister; G Putriyani; L Chaidir; R Ruslami; P Santoso; P C Hill; R van Crevel; B Alisjahbana

doi:10.5588/pha.19.0052

Early chest X-ray in persons with presumptive tuberculosis increases Xpert® MTB/RIF diagnostic yield and efficiency

Public Health Action. 2020 Mar 21;10(1):17-20. doi: 10.5588/pha.19.0052.

Authors

Z Nadiah¹, R C Koesoemadinata^{2

3

4}, S M McAllister⁵, G Putriyani², L Chaidir^{2

4

6}, R Ruslami^{2

6}, P Santoso^{2

7}, P C Hill⁵, R van Crevel⁸, B Alisjahbana^{2

7}

Affiliations

¹ Undergraduate Programme, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
² Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
³ Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
⁴ Indonesian Society for Clinical Microbiology, Bandung City, Indonesia.
⁵ Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand.
⁶ Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
⁷ Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
⁸ Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.

Abstract
in English, French, Spanish

Adult presumptive tuberculosis (TB) patients (n = 1690) were screened for TB using a questionnaire, chest X-ray (CXR) and sputum microscopy for acid-fast bacilli (AFB); Mycobacterium tuberculosis culture was performed for 74% of the patients and Xpert^® MTB/RIF was done for 17.2%. Among patients recruited, 943 (55.8%) were diagnosed with TB, of whom 870 (92.3%) were bacteriologically confirmed and 73 (7.7%) were clinically diagnosed on the basis of CXR. Using CXR prior to culture or Xpert testing reduces the number needed to screen from 7.6 to 5.0. Using CXR to triage for culture or Xpert testing reduces the number of missed cases and increases the efficiency of culture and Xpert testing.

Des patients adultes présumés atteints de TB (n = 1690) ont été dépistés à l’aide d’un questionnaire, d’une radiographie pulmonaire (CXR) et d’une microscopie de crachats à la recherche des bacilles acido-alcoolo-résistants; une culture de Mycobacterium tuberculosis a été réalisée chez 74% des patients et un test Xpert^® MTB/RIF, chez 17,2%. Parmi les patients recrutés, 943 (55,8%) ont eu un diagnostic de TB, dont 870 (92,3%) ont été confirmés par bactériologie et 73 (7,7%) ont été diagnostiqués sur la CXR. Recourir à la CXR avant la culture ou le test Xpert réduit le nombre requis pour dépister un cas de 7,6 à 5,0. L’utilisation de la CXR pour le triage avant la culture ou le test Xpert réduit les cas manqués et augmente l’efficacité de l’utilisation de la culture et de l’Xpert.

Se investigó de la tuberculosis (TB) en pacientes adultos con presunción clínica de la enfermedad (n = 1690) mediante un cuestionario, la radiografía de tórax (CXR) y la baciloscopia del esputo; se practicó el cultivo para Mycobacterium tuberculosis en 74% de los pacientes y la prueba Xpert^® MTB/RIF en 17,2%. De los pacientes que participaron se diagnosticó la TB en 943 (55,8%), de los cuales 870 (92,3%) con confirmación bacteriológica y 73 (7,7%) con diagnóstico clínico a partir de la CXR. El hecho de realizar la CXR o la prueba Xpert antes del cultivo disminuye de 7,6 a 5,0 el número de pacientes que deben someterse a detección. El uso de la CXR para seleccionar los casos en que se debe practicar el cultivo o la prueba Xpert disminuye los casos pasados por alto y aumenta la eficiencia del uso del cultivo y la prueba Xpert.

Keywords: CXR; Indonesia; bacteriological confirmation; sputum microscopy, triage.

Abstract in English, French, Spanish

Abstract
in English, French, Spanish