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 tohuman immunodeficiency virus infected patients. Therefore knowing the correct diagnosticmethod improves early detection of the disease.The burden of SNPTB is notknown in the studyarea .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 culturemethodsamonghuman immunodeficiency virus infected patients on ART follow up at Tulu boloGeneraland St. Lukas Hospitals in 2012 E.C.
Methods: A total of 197informed and consented HIV patients with suspected pulmonartuberculosis who were presented with pulmonary tuberculosis sign and symptoms of at least 2weeks or more were screened by FM smear microscopy. All 197 HIV patients’ bothsmearnegative and smear positive pooled sputum samples were further tested by gene expert in Tulubolo general Hospital and St. Luke Hospitals. Simultaneously all smear negative patients andsmear 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 MTBDRplus Ver.2 and first- line MGIT DST.Then the result was collected and data analysis wasperformed by the use of statistical software epiinfo version 7.2 and SPSS version 23. The studywas 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 positivityrate among male and female was 10/19 (52.6%) and 9/19(48.4%), respectively. From 19 culturepositive isolates, 1 (5.26%) was MDR-TB (resistant to both Rifampicin and Isoniazid); thispatient was a female patient under retreatment. Among 19 SNPTB cases14/19(73.68%) patientsviral load status were greater than 2001.and about 12/19(63.12%)of 19 SNPTB patients CD4cellresult were less than 200 cells per millimetre cube
Conclusion: In this study a significant proportion of smear negative pulmonary TB wasdiagnosed. 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 aremissed 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