Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda

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dc.contributor.authorMeyer, Amanda J.
dc.contributor.authorAtuheire, Collins
dc.contributor.authorWorodria, William
dc.contributor.authorKizito, Samuel
dc.contributor.authorKatamba, Achilles
dc.contributor.authorSanyu, Ingvar
dc.contributor.authorAndama, Alfred
dc.contributor.authorAyakaka, Irene
dc.contributor.authorCattamanchi, Adithya
dc.contributor.authorBwanga, Freddie
dc.contributor.authorHuang, Laurence
dc.contributor.authorDavis, J. Lucian
dc.date.accessioned2023-01-19T18:03:46Z
dc.date.available2023-01-19T18:03:46Z
dc.date.issued2017
dc.description.abstractIntroduction of GeneXpert MTB/RIF (Xpert) assay has constituted a major breakthrough for tuberculosis (TB) diagnostics. Several patient factors may influence diagnostic performance of Xpert including sputum quality. Objective We carried out a prospective, observational, cross-sectional study to determine the effect of sputum quality on diagnostic performance of Xpert among presumed TB patients in Uganda. Methods We collected clinical and demographic information and two sputum samples from participants. Staff recorded sputum quality and performed LED fluorescence microscopy and mycobacterial culture on each sample. If both smear examinations were negative, Xpert testing was performed. We calculated diagnostic yield, sensitivity, specificity, and other indicators for Xpert for each stratum of sputum quality in reference to a standard of mycobacterial culture. Results Patients with salivary sputum showed a trend towards a substantially higher proportion of samples that were Xpert-positive (54/286, 19%, 95% CI 15±24) compared with those with all other sputum sample types (221/1496, 15%, 95% CI 13±17). Blood-stained sputum produced the lowest sensitivity (28%; 95% CI 12±49) and salivary sputum the highest (66%; 95% CI 53±77). Specificity didn't vary meaningfully by sample types. Salivary sputum was significantly more sensitive than mucoid sputum (+13%, 95% CI +1 to +26), while bloodstained sputum was significantly less sensitive (-24%, 95% CI -42 to -5). Conclusions Our findings demonstrate the need to exercise caution in collecting sputum for Xpert and in interpreting results because sputum quality may impact test yield and sensitivity. In particular, it may be wise to pursue additional testing should blood-stained sputum test negative while salivary sputum should be readily accepted for Xpert testing given its higher sensitivity and potentially higher yield than other sample types. These findings challenge conventional recommendations against collecting salivary sputum for TB diagnosis and could inform new standards for sputum quality.en_US
dc.identifier.citationMeyer AJ, Atuheire C, Worodria W, Kizito S, Katamba A, Sanyu I, et al. (2017) Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda. PLoS ONE 12(7): e0180572. https://doi.org/10.1371/journal. pone.0180572en_US
dc.identifier.urihttps://doi.org/10.1371/journal. pone.0180572
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7076
dc.language.isoenen_US
dc.publisherPLoS ONEen_US
dc.subjectSputum qualityen_US
dc.subjectGeneXpert MTB/RIFen_US
dc.subjectSmear-negative adultsen_US
dc.subjectTuberculosisen_US
dc.titleSputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Ugandaen_US
dc.typeArticleen_US
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