title: A toolbox for tuberculosis diagnosis: an Indian multicentric study (2006-2008): microbiological results.
abstract: BACKGROUND
  The aim of this multicentric prospective study in India was to assess the value of several microbiological tools that contribute to the diagnosis of tuberculosis (TB) according to HIV status.
  
  
  METHODS
  Standard microbiological tools on individual specimens were analyzed.
  
  
  RESULTS
  Among the 807 patients with active TB, 131 were HIV-infected, 316 HIV-uninfected and 360 had HIV-unknown status. Among the 980 non-active TB subjects, 559 were at low risk and 421 were at high risk of M. tuberculosis (Mtb) exposure. Sensitivity of smear microscopy (SM) was significantly lower in HIV-infected (42.2%) than HIV-uninfected (75.9%) (p = 0.0001) and HIV-unknown pulmonary TB patients (61.4%) (p = 0.004). Specificity was 94.5% in non-TB patients and 100% in health care workers (HCW) and healthy family contacts. Automated liquid culture has significantly higher diagnostic performances than solid culture, measured by sensitivity (74.7% vs. 55.9%) (p = 0.0001) and shorter median time to detection (TTD) (12.0 vs. 34.0 days) (p = 0.0001). Specificity was 100% in HCW and cured-TB patients, but was lower in non-TB patients (89%) due to isolation of Mycobacteria other than tuberculosis (MOTT). TTD by both methods was related to AFB score. Contamination rate was low (1.4%). AccuProbe hybridization technique detected Mtb in almost all culture-positive specimens, but MOTT were found in 4.7% with a significantly higher frequency in HIV-infected (15%) than HIV-uninfected TB patients (0.5%) (p = 0.0007). Pre-test classification significantly increased the diagnostic value of all microbiological tests in pulmonary TB patients (p<0.0001) but to a lesser degree in extrapulmonary TB patients.
  
  
  CONCLUSIONS
  Conventional microbiological tools led to results similar to those already described in India special features for HIV-infected TB patients included lower detection by SM and culture. New microbiological assays, such as the automated liquid culture system, showed increased accuracy and speed of detection.
authors.affiliation: Service de Microbiologie, Hôpital Saint Louis, Assistance Publique- Hôpitaux de Paris, Paris VII Denis Diderot University, Paris, France.
authors.forename: Philippe H
authors.initials: PH
authors.lastname: Lagrange
authors.forename: Satheesh K
authors.initials: SK
authors.lastname: Thangaraj
authors.forename: Rajeshwar
authors.initials: R
authors.lastname: Dayal
authors.forename: Alka
authors.initials: A
authors.lastname: Despande
authors.forename: Nirmal K
authors.initials: NK
authors.lastname: Ganguly
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Beenu
authors.initials: B
authors.lastname: Joshi
authors.forename: Kiran
authors.initials: K
authors.lastname: Katoch
authors.forename: Vishwa M
authors.initials: VM
authors.lastname: Katoch
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.forename: Vemu
authors.initials: V
authors.lastname: Lakshmi
authors.forename: Marc
authors.initials: M
authors.lastname: Leportier
authors.forename: Christophe
authors.initials: C
authors.lastname: Longuet
authors.forename: Subbalaxmi V S
authors.initials: SV
authors.lastname: Malladi
authors.forename: Deepali
authors.initials: D
authors.lastname: Mukerjee
authors.forename: Deepthi
authors.initials: D
authors.lastname: Nair
authors.forename: Alamelu
authors.initials: A
authors.lastname: Raja
authors.forename: Balambal
authors.initials: B
authors.lastname: Raman
authors.forename: Camilla
authors.initials: C
authors.lastname: Rodrigues
authors.forename: Pratibha
authors.initials: P
authors.lastname: Sharma
authors.forename: Amit
authors.initials: A
authors.lastname: Singh
authors.forename: Sarman
authors.initials: S
authors.lastname: Singh
authors.forename: Archana
authors.initials: A
authors.lastname: Sodha
authors.forename: Basirudeen Syed Ahamed
authors.initials: BS
authors.lastname: Kabeer
authors.forename: Guy
authors.initials: G
authors.lastname: Vernet
authors.forename: Delia
authors.initials: D
authors.lastname: Goletti
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000382:microbiology; D006801:Humans; D007194:India; D008297:Male; D008828:Microbiological Techniques; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology