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Open Access Research article

Sputum microscopy for the diagnosis of HIV-associated pulmonary tuberculosis in Tanzania

Mecky Matee1*, Lillian Mtei1, Tarja Lounasvaara2, Wendy Wieland-Alter3, Richard Waddell3, Johnson Lyimo1, Muhammad Bakari1, Kisali Pallangyo1 and C Fordham von Reyn3

Author Affiliations

1 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

2 Tuberculosis Reference Laboratory, National Public Health Institute, Turku, Finland

3 Infectious Disease and International Health, Dartmouth Medical School, Lebanon, NH, USA

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BMC Public Health 2008, 8:68  doi:10.1186/1471-2458-8-68

Published: 21 February 2008

Abstract

Background

In many resource poor settings only sputum microscopy is employed for the diagnosis of HIV-associated pulmonary tuberculosis; sputum culture may not be available.

Methods

We determined the diagnostic accuracy of sputum microscopy for active case finding of HIV-associated pulmonary tuberculosis using TB culture as the reference standard.

Results

2216 potential subjects screened for a TB vaccine trial submitted 9454 expectorated sputum specimens: 212 (2.2%) were sputum culture positive for Mycobacterium tuberculosis (MTB), 31 (0.3%) for non-tuberculous mycobacteria, and 79 (0.8%) were contaminated. The overall sensitivity of sputum microscopy was 61.8% (131/212) and specificity 99.7% (9108/9132). Sputum microscopy sensitivity varied from 22.6% in specimens with < 20 colony forming units (CFU)/specimen to 94.2% in patients with > 100 CFU/specimen plus confluent growth. The incremental diagnostic value for sputum microscopy was 92.1%, 1.8% and 7.1% for the first, second and third specimens, respectively. The positive predictive value and negative predictive values for sputum microscopy were 84.5% and 99.1%, respectively. The likelihood ratio (LR) of a positive sputum microscopy was 235.1 (95% CI 155.8 – 354.8), while the LR of a negative test was 0.38 (95CI 0.32 – 0.45). The 212 positive sputum cultures for MTB represented 103 patients; sputum microscopy was positive for 57 (55.3%) of 103 patients.

Conclusion

Sputum microscopy on 3 expectorated sputum specimens will only detect 55% of culture positive HIV-infected patients in active screening for pulmonary tuberculosis. Sensitivity is higher in patients with greater numbers of CFUs in the sputum. Culture is required for active case finding of HIV- associated pulmonary tuberculosis.