Performance of Frontloading for Smear Microscopy in the Diagnosis of Pulmonary Tuberculosis A Cross-Sectional Study at a Referral Hospital in Uganda 英文参考文献.docVIP
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Performance of Frontloading for Smear Microscopy in the Diagnosis of Pulmonary Tuberculosis A Cross-Sectional Study at a Referral Hospital in Uganda 英文参考文献
PerformanceofFrontloadingforSmearMicroscopyin
theDiagnosisofPulmonaryTuberculosis:ACross-
SectionalStudyataReferralHospitalinUganda
PenelopeMiremba1,JoanN.Kalyango1,2,WilliamWorodria3,HenryMugerwa1,EthelNakakawa4,
BenonB.Asiimwe4*
1Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda, 2Department of Pharmacy, College of Health Sciences, Makerere
University,Kampala,Uganda,3DepartmentofMedicine,MulagoHospitalComplex,Kampala,Uganda,4DepartmentofMedicalMicrobiology,CollegeofHealthSciences,
MakerereUniversity,Kampala,Uganda
Abstract
Objective:TocomparetheperformanceoffrontloadingandthestandardWHOmethodfordiagnosisofpulmonaryTBat
MulagoHospitalinordertovalidatethetechniqueinthissetting.
Methods:Thiswasacross-sectionalstudyinwhich229adult($18years)TBsuspectswereconsecutivelyenrolled.Suspects
submittedthreesputumsamplesasfollows:atinitialpresentation,onehourafterthefirstsample,andthenextmorning.
The first and next morning samples formed the standard WHO method, while the first and the one hour later samples
formed the frontloading method. Sample processing was by the standard N-acetyl L-cystein (NALC)-NaOH method, and
fluorescentmicroscopywasdoneforbothmethods,whileculturesofthefirstsampleonLowenstein-Jensenslantsactedas
a gold standard. The sensitivity, specificity and predictive values for the WHO standard and frontloading methods were
compared.
Results:Thesensitivityofboththefrontloadingandstandardschemeswas91.1%whiletheirspecificitieswere86.2%and
91.7% respectively. There was excellent agreement between the diagnostic capacity of the two methods (kappa
statistic=0.87,P,0.0001).Thepositivepredictivevalueforthefrontloadingschemewas87.2%andthatforthestandard
approach was 91.9%, while the negative predictive values were 90.4% and 90.9%, respectively. Among the HIV positive
patients, frontloading identified 59/79 (74.7%) culture positive samples while the standard approach identified 55/79
(69.6%). In the HIV sero-negative category,
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