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首页> 外文期刊>The Internet Journal of Tropical Medicine >Comparison With The Smart Check Recombinant TB Serology Assay And Direct Sputum Microscopy For Acid Fast Bacilli Among Suspected HIV Positive Patients In Northeastern Nigeria
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Comparison With The Smart Check Recombinant TB Serology Assay And Direct Sputum Microscopy For Acid Fast Bacilli Among Suspected HIV Positive Patients In Northeastern Nigeria

机译：尼日利亚东北部疑似HIV阳性患者中智能检查重组TB血清学检测和直接痰液显微镜检查法检测酸性快速芽孢杆菌的比较

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Currently, the Sputum smear microscopy for acid fast bacilli is the corner stone of diagnosis of HIV associated active TB in Nguru, Northeastern Nigeria. This method has low sensitivity and specificity. In this study, we set out to compare the reliability of the Smart Check Recombinant TB rapid test kit with the routine direct sputum microscopy for acid- fast bacilli (AFB). Using Ziehl-Neelsen stained sputum smear microscopy for AFB as the standard, sensitivity and specificity of the Smart Check Recombinant TB rapid test kit was 96.7 % and 82.1 % respectively. These results show that the performance of the Smart Check Recombinant TB rapid test kit was adequate in comparison with direct sputum smear microscopy by sensitivity and specificity for the diagnosis of active TB in HIV infected patients when alternative is just clinical suspicion. Introduction In 2003, the World Health Organization (WHO) reports that tuberculosis (TB) is the leading cause of death among people who are infected with the human immunodeficiency virus (HIV) 1. Tuberculosis and HIV are a deadly duo: each speed up the progress of the other. In sub-Saharan Africa alone, approximately 31% of all new TB infections were attributable to HIV. An estimated 14 million adults in the world live with both TB and HIV; the highest number of those 14 million being reported in sub-Saharan Africa 2, 3. In Nigeria several reports have shown high prevalence of HIV- infection among TB infected patients 4,5,6,7,8. Traditional methods of diagnosis of TB include; tuberculin skin test, sputum smear microscopy, sputum culture and chest x-rays. Tuberculin skin test is of limited diagnostic value in HIV associated TB 9,10,11. Sputum smear microscopy for acid fast bacilli is the corner stone of diagnosis of pulmonary TB in most developing countries. However, in countries with a high prevalence of both TB and HIV infection, the detection rate of acid-fast bacilli by sputum smear microscopy is low. This may be partly because of the paucibacillary nature of pulmonary TB in HIV infected patients 12 and also due to lack of high quality microscopy services and shortage of skilled staff in our laboratories. Sputum culture for acid-fast bacilli using solid egg-based media (Lowenstein-Jensen medium) is the gold standard and much more sensitive than the routine sputum smear microscopy13. However, it is not readily available in most of our laboratories. Similarly, chest radiographic findings in HIV associated TB is non-specific 14. Some newer test such as DNA probes are also available but have a tendency for a high degree of false positive in high prevalence areas. These tests are also expensive and not practical for developing countries. New serological tests such as the Smart Check Recombinant TB rapid test are among the simplest and fastest means of detecting active mycobacterium tuberculosis infection in HIV infected patients. In this study, we set out to compare the reliability of the Smart Check Recombinant TB rapid test kit with the routine direct sputum microscopy for acid- fast bacilli (AFB). Materials And Methods This was a prospective study carried out at the Federal Medical Centre Nguru, Yobe State. Nguru, the headquarters of Nguru Local Government Area of Yobe State, northeastern Nigeria is situated in the extreme northern part of the state. It is an arid zone situated in the Sahel Savannah surrounded by wetlands- the Hadejia-Nguru wetlands. The mean annual temperature is 32°C to 42°C while the annual rainfall is below 100cm lasting for a period of three months from July to September. The main occupations of the people are subsistence farming and fishing and lack basic amenities like piped-borne water, electricity and proper waste disposal facilities. The Hospital is a Federal Medical Center established 8 years ago and serves the population and the surrounding villages, some of which take about four hours by hand- peddle canoe and one hour to reach by motorized boats. This area is e
机译：目前，耐酸杆菌的痰涂片镜检术是诊断尼日利亚东北部恩古鲁（Nguru）与HIV相关的活动性结核的诊断基石。该方法的敏感性和特异性低。在这项研究中，我们着手比较Smart Check Recombinant TB快速检测试剂盒与常规的直接痰镜检查抗酸杆菌（AFB）的可靠性。以Ziehl-Neelsen染色痰涂片镜检作为AFB的标准，Smart Check Recombinant TB快速检测试剂盒的敏感性和特异性分别为96.7％和82.1％。这些结果表明，与直接痰涂片镜检相比，Smart Check Recombinant TB快速检测试剂盒的性能和敏感性足以诊断HIV感染患者的活动性TB，而其他选择只是临床怀疑。引言2003年，世界卫生组织（WHO）报告说，结核病（TB）是感染人类免疫缺陷病毒（HIV）的人群中的主要死亡原因。1结核病和HIV是致命的二重奏：两者都加速了人类的生存。其他的进度。仅在撒哈拉以南非洲，所有新发结核感染中约有31％归因于艾滋病毒。全世界估计有1400万人患有结核病和艾滋病毒;在撒哈拉以南非洲地区2、3、3、4、5、6、7、8中，报告的1400万人中最高。在尼日利亚，一些报告显示，艾滋病毒感染率很高。传统的结核病诊断方法包括：结核菌素皮肤试验，痰涂片镜检，痰培养和胸部X线检查。结核菌素皮肤测试在与HIV相关的TB 9,10,11中具有有限的诊断价值。在大多数发展中国家，痰涂片镜检耐酸性杆菌是诊断肺结核的基石。但是，在结核病和艾滋病毒感染率都很高的国家，痰涂片显微镜检出的抗酸杆菌的检出率很低。这可能部分是由于感染HIV的患者12的肺结核具有脓杆菌性质，也可能是由于缺乏高质量的显微镜检查服务以及实验室缺乏熟练的工作人员。使用基于固体蛋的培养基（Lowenstein-Jensen培养基）进行抗酸杆菌的痰培养是金标准，并且比常规的痰涂片显微镜检查更为敏感13。但是，在我们的大多数实验室中并不容易获得。同样，与HIV相关的结核病的胸部影像学检查结果也是非特异性的14。也可以使用一些较新的检测方法，例如DNA探针，但在高流行地区有很高的假阳性率。这些测试也很昂贵，对发展中国家不切实际。新的血清学检测（例如Smart Check重组TB快速检测）是检测HIV感染患者中活动性结核分枝杆菌感染的最简单，最快的方法之一。在这项研究中，我们着手比较Smart Check Recombinant TB快速检测试剂盒与常规的直接痰镜检查抗酸杆菌（AFB）的可靠性。材料和方法这是在尤伯州恩古鲁联邦医学中心进行的一项前瞻性研究。尼古鲁（Nguru）是尼日利亚东北部尤贝州（Yube）尼古鲁地方政府区的总部，位于该州的最北部。这是一个干旱地区，位于萨赫勒萨凡纳（Sahel Savannah），周围是湿地-哈德加-努古鲁湿地。年平均气温为32°C至42°C，而年降雨量低于100厘米，持续7个月至9月的三个月。人民的主要职业是自给农业和渔业，缺乏基本的便利设施，例如自来水，电和适当的废物处理设施。该医院是一家成立于8年前的联邦医疗中心，为居民和周围的村庄服务，其中一些村庄通过手推独木舟大约需要4个小时，而机动船则需要1个小时。这个区域是

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