Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis.
OBJECTIVE
Use of the polymerase chain reaction for the detection of Mycobacterium tuberculosis (TB PCR) as a basis for making clinical decisions on the initiation of antituberculosis treatment was studied.


METHODS
A retrospective study involving a cohort of 155 patients being investigated for tuberculosis in an infectious disease consultation service was undertaken. TB PCR was performed on pulmonary and extrapulmonary specimens from these patients. The sensitivity of TB PCR was analysed.


RESULTS
Of the 155 patients, 144 fitted the clinical diagnosis of tuberculosis, and 112 of them were culture positive for M tuberculosis. Sixty (58.3%) patients with clinical features suggestive of tuberculosis received antituberculosis treatment based on positive TB PCR alone. Of 224 clinical specimens (138 pulmonary and 86 extrapulmonary) sent for TB PCR, 148 (99 pulmonary and 49 extrapulmonary) were positive in 117 patients. Of the 690 clinical specimens sent for culture, 279 were positive for M tuberculosis in 112 patients. The diagnostic sensitivity of TB PCR was 75.9% (85 of 112) and 81.3% (117 of 144) in patients with culture confirmed and clinically diagnosed tuberculosis, respectively. Using culture as the gold standard, the overall sensitivity of TB PCR was 78.3%, and for pulmonary and extrapulmonary specimens it was 82.3% and 72.0%, respectively.


CONCLUSIONS
TB PCR is a rapid and reliable test in the diagnosis and management of tuberculosis.
Division of Infectious Diseases, Centre of Infection, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong ROC.
V C C
VC
Cheng
W C
WC
Yam
I F N
IF
Hung
P C Y
PC
Woo
S K P
SK
Lau
B S F
BS
Tang
K Y
KY
Yuen
D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003657:Decision Making; D006801:Humans; D008168:Lung / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
D000995:Antitubercular Agents