Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases.
SETTING:A high proportion of notified tuberculosis cases in the Philippines are clinically diagnosed (63%) as opposed to bacteriologically confirmed. Better understanding of this phenomenon is required to improve tuberculosis control. OBJECTIVES:To determine the percentage of smear negative presumpt...
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doaj-37197008092949b48d13d60f696089172021-03-03T21:20:52ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-011412e022709310.1371/journal.pone.0227093Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases.Jovilia AbongVictoria DalayIvor LangleyEwan TomenyDanaida MarceloVictor MendozaArvin Christian AquinoAnna Marie Celina GarfinBertie SquireCharles YuSETTING:A high proportion of notified tuberculosis cases in the Philippines are clinically diagnosed (63%) as opposed to bacteriologically confirmed. Better understanding of this phenomenon is required to improve tuberculosis control. OBJECTIVES:To determine the percentage of smear negative presumptive tuberculosis patients that would be diagnosed by GeneXpert; compare clinical characteristics of patients diagnosed as tuberculosis cases; and review the impact that the current single government physician and a reconstituted Tuberculosis Diagnostic committee (expert panel) may have on tuberculosis over-diagnosis. DESIGN:This a cross-sectional study of 152 patients 15-85 years old with two negative Direct Sputum Smear Microscopy results, with abnormal chest X-ray who underwent GeneXpert testing and review by an expert panel. RESULTS:Thirty-two percent (48/152) of the sample were Xpert positive and 93% (97/104) of GeneXpert negatives were clinically diagnosed by a single physician. Typical symptoms and X-ray findings were higher in bacteriologically confirmed tuberculosis. When compared to the GeneXpert results the Expert panel's sensitivity for active tuberculosis was high (97.5%, 39/40), specificity was low (40.2%, 35/87). CONCLUSION:Using the GeneXpert would increase the level of bacteriologically confirmed tuberculosis substantially among presumptive tuberculosis. An expert panel will greatly reduce over-diagnosis usually seen when a decision is made by a single physician.https://doi.org/10.1371/journal.pone.0227093 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jovilia Abong Victoria Dalay Ivor Langley Ewan Tomeny Danaida Marcelo Victor Mendoza Arvin Christian Aquino Anna Marie Celina Garfin Bertie Squire Charles Yu |
spellingShingle |
Jovilia Abong Victoria Dalay Ivor Langley Ewan Tomeny Danaida Marcelo Victor Mendoza Arvin Christian Aquino Anna Marie Celina Garfin Bertie Squire Charles Yu Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. PLoS ONE |
author_facet |
Jovilia Abong Victoria Dalay Ivor Langley Ewan Tomeny Danaida Marcelo Victor Mendoza Arvin Christian Aquino Anna Marie Celina Garfin Bertie Squire Charles Yu |
author_sort |
Jovilia Abong |
title |
Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. |
title_short |
Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. |
title_full |
Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. |
title_fullStr |
Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. |
title_full_unstemmed |
Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. |
title_sort |
use of genexpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2019-01-01 |
description |
SETTING:A high proportion of notified tuberculosis cases in the Philippines are clinically diagnosed (63%) as opposed to bacteriologically confirmed. Better understanding of this phenomenon is required to improve tuberculosis control. OBJECTIVES:To determine the percentage of smear negative presumptive tuberculosis patients that would be diagnosed by GeneXpert; compare clinical characteristics of patients diagnosed as tuberculosis cases; and review the impact that the current single government physician and a reconstituted Tuberculosis Diagnostic committee (expert panel) may have on tuberculosis over-diagnosis. DESIGN:This a cross-sectional study of 152 patients 15-85 years old with two negative Direct Sputum Smear Microscopy results, with abnormal chest X-ray who underwent GeneXpert testing and review by an expert panel. RESULTS:Thirty-two percent (48/152) of the sample were Xpert positive and 93% (97/104) of GeneXpert negatives were clinically diagnosed by a single physician. Typical symptoms and X-ray findings were higher in bacteriologically confirmed tuberculosis. When compared to the GeneXpert results the Expert panel's sensitivity for active tuberculosis was high (97.5%, 39/40), specificity was low (40.2%, 35/87). CONCLUSION:Using the GeneXpert would increase the level of bacteriologically confirmed tuberculosis substantially among presumptive tuberculosis. An expert panel will greatly reduce over-diagnosis usually seen when a decision is made by a single physician. |
url |
https://doi.org/10.1371/journal.pone.0227093 |
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