Abstract
Diagnosing pulmonary tuberculosis (TB) may be delayed until culture results become available.
We ascertained the accuracy of a stepwise diagnostic algorithm for the rapid diagnosis of pulmonary TB by GeneXpert from sputum and/or bronchoalveolar lavage (BAL) followed by a Mycobacterium tuberculosis-specific BAL ELISPOT assay in patients with a suspected diagnosis of pulmonary TB at a clinical referral centre in Germany.
Among 166 patients with a presumptive diagnosis of pulmonary TB, 81 cases were confirmed by M. tuberculosis culture from sputum and/or BAL. In 66 out of 81 (81.5%) cases, patients initially had M. tuberculosis detected by GeneXpert from sputum; in addition, six out of 81 (7.4%) cases were diagnosed by GeneXpert on BAL fluid (together 72 out of 81 (88.9%) patients). Out of the remaining nine patients with negative GeneXpert results from sputum and BAL, BAL ELISPOT identified eight patients with culture-confirmed TB correctly (median time to culture positivity 26 days). At a cut-off of >4000 early secretory antigenic target-6- or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 000 0000 lymphocytes, the specificity of the BAL ELISPOT for active TB was 97%.
In low TB incidence countries, nearly all patients with active pulmonary TB can be identified within the first few days of clinical presentation using a stepwise strategy with GeneXpert and BAL ELISPOT.
Abstract
Nearly all patients with active pulmonary TB can be rapidly identified when two diagnostic methods are combined http://ow.ly/vinu30j5Yk7
Footnotes
This article has supplementary material available from erj.ersjournals.com
Conflict of interest: J. Heyckendorf has received personal fees for sponsor-independent lectures at sponsored symposia from Chiesi, Gilead, Janssen, Lucane and Hain, outside the submitted work. C. Lange has received personal fees for sponsor-independent lectures at sponsored symposia from Chiesi, Gilead, Abbvie, MSD, Becton Dickinson, Janssen, Lucane, Novartis and Thermo Fisher, outside the submitted work. B. Kalsdorf has received personal fees for sponsor-independent lectures at sponsored symposia from Oxford Immunotec and Lucane, outside the submitted work.
Support statement: C. Lange and J. Heyckendorf are supported by the German Center for Infection Research (DZIF). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received October 24, 2017.
- Accepted March 14, 2018.
- Copyright ©ERS 2018
INDIVIDUALS
Log in using your username and password
LIBRARY USERS
Log in through your institution
Purchase access
CONTACT US
If you have any questions about the ERS publications website, please contact journals@ersnet.org
