RESUMO
SETTING: Public health care services in the provinces of Buenos Aires, Santa Fe, Jujuy and Santa Cruz, Argentina. OBJECTIVE: To evaluate delays in tuberculosis (TB) diagnosis and treatment and associated risk factors in departments and administrative areas of four Argentine provinces. DESIGN: Cross-sectional survey including retrospective medical record review and patient interviews. RESULTS: A total of 243 patients with smear-positive pulmonary TB and a mean age of 40 years were included in the study. The mean diagnostic delays were as follows: total delay 92.1 days (median 62.0); patient delay 58.8 days (median 31); health service delay 32.6 days (median 12.5). The mean treatment delay was 0.9 days (median 0). Associations were observed between patient delays of >30 days and residence in Jujuy, age >50 years, dependence on transport to the nearest public health service due to distance and presence of cough. The >60-day total diagnosis delay was associated with age >50 years and need for transport to the nearest public health service. CONCLUSION: Diagnostic delay is an important problem in the areas studied, with patient delay being of most concern. Patient delay was associated with age >50 years, dependence on transport to the nearest public health service due to distance and presence of cough.
Assuntos
Antituberculosos/uso terapêutico , Técnicas Bacteriológicas , Acessibilidade aos Serviços de Saúde , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Criança , Tosse/microbiologia , Estudos Transversais , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Características de Residência , Estudos Retrospectivos , Fatores de Tempo , Transporte de Pacientes , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologiaRESUMO
Microscopy with the Ziehl-Neelsen (ZN) stain is frequently negative in paucibacillary tuberculosis (TB) so that the treatment must be started and continued until the culture results confirm or not the disease. LCx Mycobacterium tuberculosis Assay (Abbott, Lab.) uses the ligase chain reaction for direct amplification of DNA and rapid detection of M. tuberculosis Complex (MTB) in clinical specimens. We evaluated the usefulness of the LCx assay on 1,203 clinical samples: 737 respiratory and 466 extrapulmonary specimens. The LCx results were compared with those obtained by ZN and cultures on solid media and Mycobacteria Growth Indicator Tube (MGIT, Becton Dickinson, Argentina). Since detection and identification of MTB are simultaneously made by the LCx assay, a total of 145 out of 183 patients (79.2%) had a confirmed TB diagnosis in two working days. Positive culture results were predicted in 122 out of 160 cases (76.3%) by LCx and in 70 (43.8%) by ZN as well. The sensitivity (S) and specificity (ES) of LCx assay in ZN positive cases were 93.4% and 100.0% while in ZN negative cases they were 68.0% and 98.6%. The overall S and ES were 79.2% and 98.7%, respectively. We conclude that the LCx assay is a rapid and sensitive technique, which can be a helpful diagnostic tool mainly for paucibacillary TB in reference laboratories.
Assuntos
Reação em Cadeia da Polimerase , Kit de Reagentes para Diagnóstico , Tuberculose/diagnóstico , Adulto , Técnicas Bacteriológicas , Biópsia , Líquidos Corporais/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , DNA Bacteriano/análise , Fezes/microbiologia , Conteúdo Gastrointestinal/microbiologia , Infecções por HIV/complicações , Humanos , Fígado/microbiologia , Fígado/patologia , Linfonodos/microbiologia , Linfonodos/patologia , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/crescimento & desenvolvimento , Mycobacterium tuberculosis/isolamento & purificação , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Escarro/microbiologia , Coloração e Rotulagem , Fatores de Tempo , Tuberculose/complicações , Tuberculose/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Urina/microbiologiaRESUMO
Microscopy with the Ziehl-Neelsen (ZN) stain is frequently negative in paucibacillary tuberculosis (TB) so that the treatment must be started and continued until the culture results confirm or not the disease. LCx Mycobacterium tuberculosis Assay (Abbott, Lab.) uses the ligase chain reaction for direct amplification of DNA and rapid detection of M. tuberculosis Complex (MTB) in clinical specimens. We evaluated the usefulness of the LCx assay on 1,203 clinical samples: 737 respiratory and 466 extrapulmonary specimens. The LCx results were compared with those obtained by ZN and cultures on solid media and Mycobacteria Growth Indicator Tube (MGIT, Becton Dickinson, Argentina). Since detection and identification of MTB are simultaneously made by the LCx assay, a total of 145 out of 183 patients (79.2
) had a confirmed TB diagnosis in two working days. Positive culture results were predicted in 122 out of 160 cases (76.3
) by LCx and in 70 (43.8
) by ZN as well. The sensitivity (S) and specificity (ES) of LCx assay in ZN positive cases were 93.4
and 100.0
while in ZN negative cases they were 68.0
and 98.6
. The overall S and ES were 79.2
and 98.7
, respectively. We conclude that the LCx assay is a rapid and sensitive technique, which can be a helpful diagnostic tool mainly for paucibacillary TB in reference laboratories.
RESUMO
Microscopy with the Ziehl-Neelsen (ZN) stain is frequently negative in paucibacillary tuberculosis (TB) so that the treatment must be started and continued until the culture results confirm or not the disease. LCx Mycobacterium tuberculosis Assay (Abbott, Lab.) uses the ligase chain reaction for direct amplification of DNA and rapid detection of M. tuberculosis Complex (MTB) in clinical specimens. We evaluated the usefulness of the LCx assay on 1,203 clinical samples: 737 respiratory and 466 extrapulmonary specimens. The LCx results were compared with those obtained by ZN and cultures on solid media and Mycobacteria Growth Indicator Tube (MGIT, Becton Dickinson, Argentina). Since detection and identification of MTB are simultaneously made by the LCx assay, a total of 145 out of 183 patients (79.2
) had a confirmed TB diagnosis in two working days. Positive culture results were predicted in 122 out of 160 cases (76.3
) by LCx and in 70 (43.8
) by ZN as well. The sensitivity (S) and specificity (ES) of LCx assay in ZN positive cases were 93.4
while in ZN negative cases they were 68.0
. The overall S and ES were 79.2
, respectively. We conclude that the LCx assay is a rapid and sensitive technique, which can be a helpful diagnostic tool mainly for paucibacillary TB in reference laboratories.