Burden of smear negative pulmonary tuberculosis using genexpert and culture methods among human immunodeficiency virus infected patients in tulubolo and St.luke hospital south west shewa, Ethiopia
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Date
2020-06
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Addis Abeba University
Abstract
Background: Smear negative pulmonary tuberculosis(SNPTB)leads to a serious disease to
human immunodeficiency virus infected patients. Therefore knowing the correct diagnostic
method improves early detection of the disease.The burden of SNPTB is not known in the study
area .Therefore, this study aimed to determine the burden of TB, MDR-TB, in Tulu bolo and St.
Luke hospitals,south west shewa Ethiopia.
Objective: To determine the burden of SNPTB using genexpert and culture
methodsamonghuman immunodeficiency virus infected patients on ART follow up at Tulu bolo
Generaland St. Lukas Hospitals in 2012 E.C.
Methods: A total of 197informed and consented HIV patients with suspected pulmonary
tuberculosis who were presented with pulmonary tuberculosis sign and symptoms of at least 2
weeks or more were screened by FM smear microscopy. All 197 HIV patients’ bothsmear
negative and smear positive pooled sputum samples were further tested by gene expert in Tulu
bolo general Hospital and St. Luke Hospitals. Simultaneously all smear negative patients and
smear positive patients were allowed to give samples which were sent to EPHI for MTB culture
(LJ and MGIT), and LPA test.All drug resistant isolates were tested by using Genotype MTBDR
plus Ver.2 and first- line MGIT DST.Then the result was collected and data analysis was
performed by the use of statistical software epiinfo version 7.2 and SPSS version 23. The study
was conducted from December 1, 2019 to February 30, 2020
Results: From the total of 197 enrolled HIV patients, 5/197(2.54%)were smear positive,19/192
(9.9%) were Xpert MTB/ RIF and culture confirmed smear negative PTB patients. The positivity
rate among male and female was 10/19 (52.6%) and 9/19(48.4%), respectively. From 19 culture
positive isolates, 1 (5.26%) was MDR-TB (resistant to both Rifampicin and Isoniazid); this
patient was a female patient under retreatment. Among 19 SNPTB cases14/19(73.68%) patients
viral load status were greater than 2001.and about 12/19(63.12%)of 19 SNPTB patients CD4cell
result were less than 200 cells per millimetre cube
Conclusion: In this study a significant proportion of smear negative pulmonary TB was
diagnosed. Further, a smear negative multi drug resistant (MDR) TB was confirmed. Due to thelimitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are
missed to be diagnosed, mortality in HIV patients and transmission in the communitycontinues.
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Keywords
ART Patient, Smear negative patient, Detection,Culture,Genexpert, FMmicroscopy, burden