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Observational Study
. 2019 Dec 30;14(12):e0227093.
doi: 10.1371/journal.pone.0227093. eCollection 2019.

Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases

Jovilia Abong  1 , Victoria Dalay  1 , Ivor Langley  2 , Ewan Tomeny  2 , Danaida Marcelo  1 , Victor Mendoza  1 , Arvin Christian Aquino  1 , Anna Marie Celina Garfin  3 , Bertie Squire  2 , Charles Yu  1
Affiliations
Observational Study

Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases

Jovilia Abong et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Diagnostic outcome of 152 smear negative presumptive TB patients.
See this image and copyright information in PMC

References

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MeSH terms