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Int J Tuberc Lung Dis. 2017 Nov 1;21(11):1127-1133. doi: 10.5588/ijtld.17.0139.

Accuracy of giant African pouched rats for diagnosing tuberculosis: comparison with culture and Xpert® MTB/RIF.

Author information

1
Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania, Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
2
Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania.
3
Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania, Waikato University, Hamilton, New Zealand.
4
Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania, Vanderbilt University Medical School, Nashville, Tennessee.
5
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA, Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
6
Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
7
Waikato University, Hamilton, New Zealand.

Abstract

SETTING:

Enhanced tuberculosis (TB) case finding using detection rats in Tanzania.

OBJECTIVES:

To assess the diagnostic accuracy of detection rats compared with culture and Xpert® MTB/RIF, and to compare enhanced case-finding algorithms using rats in smear-negative presumptive TB patients.

DESIGN:

A fully paired diagnostic accuracy study in which sputum of new adult presumptive TB patients in Tanzania was tested using smear microscopy, 11 detection rats, culture and Xpert.

RESULTS:

Of 771 eligible participants, 345 (45%) were culture-positive for Mycobacterium tuberculosis, and 264 (34%) were human immunodeficiency virus (HIV) positive. The sensitivity of the detection rats was up to 75.1% (95%CI 70.1-79.5) when compared with culture, and up to 81.8% (95%CI 76.0-86.5) when compared with Xpert, which was statistically significantly higher than the sensitivity of smear microscopy. Corresponding specificity was 40.6% (95%CI 35.9-45.5) compared with culture. The accuracy of rat detection was independent of HIV status. Using rats for triage, followed by Xpert, would result in a statistically higher yield than rats followed by light-emitting diode fluorescence microscopy, whereas the number of false-positives would be significantly lower than when using Xpert alone.

CONCLUSION:

Although detection rats did not meet the accuracy criteria as standalone diagnostic or triage testing for presumptive TB, they have additive value as a triage test for enhanced case finding among smear-negative TB patients if more advanced diagnostics are not available.

Comment in

PMID:
29037292
DOI:
10.5588/ijtld.17.0139
[Indexed for MEDLINE]

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