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The MODS method for diagnosis of tuberculosis and multidrug resistant tuberculosis
Published on: August 11, 2008
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Multiple microbiologic tests for tuberculosis improve diagnostic yield of bronchoscopy in medically complex patients
Dilshaad Fakey Khan1, Moosa Suleman1, Prinita Baijnath1
1Department of Pulmonology, Inkosi Albert Luthuli Central Hospital, Durban, KZN, 4000, South Africa.
AAS Open Research
|May 9, 2020
Summary
Diagnosing tuberculosis (TB) in complex lung disease is challenging. Using two Xpert MTB/RIF tests on bronchoalveolar lavage fluid significantly improves the diagnostic yield compared to TB culture alone.
Area of Science:
- Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Bronchoalveolar lavage (BAL) aids in diagnosing complex lung diseases.
- Limited data exists on tuberculosis (TB) diagnostic test performance in BAL fluid, especially in HIV-endemic regions.
- High prevalence of immunosuppression was noted in the study population.
Purpose of the Study:
- To evaluate the performance of Mycobacterium tuberculosis (Mtb) culture and Xpert MTB/RIF assays on BAL fluid.
- To assess diagnostic yield in medically complex patients undergoing bronchoscopy in a TB-endemic area.
- To compare the diagnostic accuracy of Xpert MTB/RIF against a consensus clinical diagnosis.
Main Methods:
- Prospective evaluation of 98 medically complex patients in Durban, South Africa.
- Analysis of BAL fluid using Mtb culture and up to two simultaneous Xpert MTB/RIF tests.
- Comparison of test results against a consensus clinical diagnosis for TB.
Main Results:
- Tuberculosis was the most common diagnosis (19%), microbiologically confirmed in 74% of cases.
- Xpert MTB/RIF demonstrated low sensitivity (45%) but high specificity (99%).
- Employing two Xpert MTB/RIF tests increased the diagnostic yield by 27% compared to culture alone.
Conclusions:
- While Xpert MTB/RIF has limitations in sensitivity, its use in conjunction with culture improves TB diagnosis.
- Performing two simultaneous Xpert MTB/RIF tests on BAL fluid significantly enhances the microbiologically-proven diagnostic yield.
- This strategy is valuable for diagnosing TB in medically complex patients in high-burden settings.
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