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Eur Respir J. 2018 May 3;51(5). pii: 1702189. doi: 10.1183/13993003.02189-2017. Print 2018 May.

Rapid diagnosis of pulmonary tuberculosis by combined molecular and immunological methods.

Author information

1
Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
2
Both authors contributed equally.
3
Biomedical Research and Training Institute, Harare, Zimbabwe.
4
Division of Immune Cell Analytics, Research Center Borstel, Borstel, Germany.
5
International Health/Infectious Diseases, University of Lübeck, German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Lübeck, Germany.
6
Dept of Medicine, Karolinska Institutet, Stockholm, Sweden.

Abstract

Diagnosing pulmonary tuberculosis (TB) may be delayed until culture results become available.We ascertained the accuracy of a stepwise diagnostic algorithm for the rapid diagnosis of pulmonary TB by GeneXpert from sputum and/or bronchoalveolar lavage (BAL) followed by a Mycobacterium tuberculosis-specific BAL ELISPOT assay in patients with a suspected diagnosis of pulmonary TB at a clinical referral centre in Germany.Among 166 patients with a presumptive diagnosis of pulmonary TB, 81 cases were confirmed by M. tuberculosis culture from sputum and/or BAL. In 66 out of 81 (81.5%) cases, patients initially had M. tuberculosis detected by GeneXpert from sputum; in addition, six out of 81 (7.4%) cases were diagnosed by GeneXpert on BAL fluid (together 72 out of 81 (88.9%) patients). Out of the remaining nine patients with negative GeneXpert results from sputum and BAL, BAL ELISPOT identified eight patients with culture-confirmed TB correctly (median time to culture positivity 26 days). At a cut-off of >4000 early secretory antigenic target-6- or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 000 0000 lymphocytes, the specificity of the BAL ELISPOT for active TB was 97%.In low TB incidence countries, nearly all patients with active pulmonary TB can be identified within the first few days of clinical presentation using a stepwise strategy with GeneXpert and BAL ELISPOT.

Conflict of interest statement

Conflict of interest: J. Heyckendorf has received personal fees for sponsor-independent lectures at sponsored symposia from Chiesi, Gilead, Janssen, Lucane and Hain, outside the submitted work. C. Lange has received personal fees for sponsor-independent lectures at sponsored symposia from Chiesi, Gilead, Abbvie, MSD, Becton Dickinson, Janssen, Lucane, Novartis and Thermo Fisher, outside the submitted work. B. Kalsdorf has received personal fees for sponsor-independent lectures at sponsored symposia from Oxford Immunotec and Lucane, outside the submitted work.

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