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Algorithms for Screening for Active Tuberculosis among Individuals with Latent Tuberculosis Infection in a Rural
Henan Xin1,2, Ying Du1,2, Xuefang Cao1,2
1NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Microbiology Spectrum
|November 29, 2022
Summary
Screening for active tuberculosis (TB) in individuals with latent TB infection (LTBI) is crucial. The Xpert MTB/RIF assay showed high sensitivity for active TB detection, but cost and combined algorithm performance require further study for effective community screening.
Area of Science:
- Public Health
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Screening for active tuberculosis (TB) in individuals with latent TB infection (LTBI) is essential for TB preventive treatment.
- Optimal screening algorithms for active TB in LTBI populations in rural China are not well-established.
Purpose of the Study:
- To evaluate the performance of various diagnostic tools and algorithms for screening active TB among LTBI individuals in rural China.
Main Methods:
- Sputum samples analyzed by microscopy, culture, and Xpert MTB/RIF assay.
- Chest digital radiography and TB symptoms were also assessed.
- Performance compared against sputum culture as the gold standard.
Main Results:
- Xpert MTB/RIF assay demonstrated the highest sensitivity (80%) among individual tests.
- Combining Xpert MTB/RIF with chest radiography achieved 90% sensitivity but reduced positive predictive value.
- Xpert MTB/RIF alone showed the best agreement with sputum culture (kappa=0.840).
Conclusions:
- Xpert MTB/RIF assay offers high sensitivity for active TB screening in LTBI populations.
- Combined algorithms increase sensitivity but may decrease specificity and increase costs.
- Further research is needed to develop cost-effective, high-throughput screening strategies for active TB in LTBI individuals.
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