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Tuberculosis: Diagnostic Evaluation


12:30 PM - 2:00 PM

DIAGNOSIS OF PULMONARY TUBERCULOSIS IN PATIENTS WITH CLINICAL OR RADIOLOGICAL EVIDENCE OF DISEASE AND NEGATIVE SPUTUM

Viviane R. Figueiredo, MD, Francisco S. Vargas, MD, Márcia Seiscento, MD, Jorge Kawakama, MD, Milena M. Acencio, BS, César L. Moreira, BS, Evaldo Marchi, MD and Leila Antonangelo, MD*

Pulmonary Division-Heart Institute (InCor) and Department of Pathology, São Paul, São Paulo, Brazil

PURPOSE: To evaluate the performance of laboratorial tests in diagnosing tuberculosis in patients with clinical or radiological evidence of disease but with negative sputum.

METHODS: Thirty-four patients with clinical (cough, fever, weigh loss) or radiological (micronodules, consolidation, cavitation, nodules) suspicion of pulmonary tuberculosis but having negative sputum were submmited to fiberoptic broncoscopy to obtain bronchoalveolar lavage (BAL). Sensitivity, Specificity, PPV and NPV of BAL smear, culture, PCR and ADA (cut-off 2.5 U/L); bronchial biopsy;smear and culture from induced sputum (collected after the BAL)and PPD were evaluated.

RESULTS: From the 34 patients with tuberculosis suspicion, only 22 (64.7%) had been confirmed the diagnosis. The performance of the tests is showed in the table bellow.

CONCLUSION: PPD and cultures (BAL and sputum) were the most sensitive methods for the diagnosis of pulmonary tuberculosis. However, due to the low specificity of the PPD, this test may be judged with criteria in places where there is high prevalence of tuberculosis.

CLINICAL IMPLICATIONS: The diagnosis of tuberculosis in patients with negative sputum is a clinical problem all over the world. The association of multiple laboaratory tests can improve the diagnosis field.
BAL smear BAL culture BAL PCR BAL ADA Bronchial biopsy Pos BAL smear Pos BAL culture PPD
Sensituvity (%) 13.6 66.7 35 35.7 31.8 21.1 53.3 90
Specificity (%) 100 100 100 60 100 100 100 14.3
PPV(%) 100 100 100 54.5 100 100 100 60.0
NPV(%) 38.7 57.1 48.0 30.0 44.4 55.5 53.3 50

DISCLOSURE: Leila Antonangelo, None.






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Copyright © 2005 by the American College of Chest Physicians.