title: Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission.
abstract: There have been few studies evaluating the efficacy of polymerase chain reaction (PCR) testing in front-line clinical practice. We assessed the diagnostic yield of PCR prospectively in a blinded study of patients admitted to rule out tuberculosis and compared PCR results to a culture and clinical diagnosis of tuberculosis. Specimens were sent for routine smear, culture, and PCR analysis. Sputum sediments were submitted for PCR amplification of IS6110 sequences by an in-house assay and also the Roche Amplicor PCR assay targeting 16s ribosomal RNA genes. Eighty-five patients were enrolled: 27 patients had cultures positive for tuberculosis; 12 were smear-positive. PCR by both assays on the first specimen picked up all patients smear-positive on any specimen. A positive PCR on at least one of two specimens collected in the first 24 h was 85 and 74% sensitive and 88 and 93% specific for tuberculosis by the in-house and Roche techniques, respectively. Sensitivity in smear-negative patients was 73 and 53%, respectively. The in-house PCR detected 100% and Roche detected 95% of patients with more than paucibacillary (greater than 20 colonies) tuberculosis. We conclude that PCR may be a useful tool to evaluate patients for tuberculosis within the first hospital day.
authors.affiliation: Department of Pulmonary Medicine/Critical Care, Cook County Hospital, and Rush Medical College, Chicago, Illinois 60612, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Muzaffar
authors.forename: D
authors.initials: D
authors.lastname: Schwartz
authors.forename: S
authors.initials: S
authors.lastname: Bashir
authors.forename: S
authors.initials: S
authors.lastname: Luke
authors.forename: L P
authors.initials: LP
authors.lastname: McGartland
authors.forename: K
authors.initials: K
authors.lastname: Kaul
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D010343:Patient Admission; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012329:RNA, Bacterial / Q000032:analysis*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S