title: Evaluation of the 2007 WHO guideline to diagnose smear negative tuberculosis in an urban hospital in Ethiopia.
abstract: BACKGROUND
  The 2007 World Health Organization (WHO) guideline to diagnose smear-negative tuberculosis (TB) in HIV-prevalent settings was mainly based on expert advice and therefore requires evaluation in real life situations.
  
  
  METHODS
  In 2009, this guideline was introduced at the ALERT hospital in Ethiopia. From October 2009 to January 2011, the accuracy of the guideline was evaluated using Mycobacterium tuberculosis culture positivity as reference standard in HIV positive TB suspects.
  
  
  RESULTS
  A total of 459 TB suspects were enrolled during the study period; 336 (73.2%) were HIV positive. Acid fast bacilli sputum smear microscopy was done for 74.7% (251/336) HIV positive TB suspects; 94.4% (237/251) were smear negative. A chest X-ray was performed in 92.8% (220/237) and a Mycobacterium tuberculosis culture in 63.7% (151/237). The median TB diagnostic delay for smear negative cases was 3 days (interquartile range 3-4 days). Of the 75 patients diagnosed with smear negative pulmonary TB, 89. 4% (67/75) were diagnosed by chest X-ray, 9.4% (7/75) by culture and 1.3% (1/75) by clinical suspicion only. In 147 smear negative TB suspects Mycobacterium tuberculosis culture and chest X-ray results were available. Among these 147 patients, the sensitivity of the chest X-ray to diagnose smear negative TB in HIV-positive TB suspects was 53.3% (95% CI: 26.7-78.7); the specificity 67.4% (95% CI: 58.7-75.3).
  
  
  CONCLUSIONS
  The 2007 WHO diagnostic algorithm for the diagnosis of smear negative TB is likely to reduce the diagnostic delay and therefore decrease morbidity and mortality of TB in a HIV prevalent settings like Ethiopia.
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia. gemeda.abebe@ju.edu.et.
authors.forename: Gemeda
authors.initials: G
authors.lastname: Abebe
authors.forename: Amare
authors.initials: A
authors.lastname: Deribew
authors.forename: Ludwig
authors.initials: L
authors.lastname: Apers
authors.forename: Alemseged
authors.initials: A
authors.lastname: Abdissa
authors.forename: Yibeltal
authors.initials: Y
authors.lastname: Kiflie
authors.forename: Olivier
authors.initials: O
authors.lastname: Koole
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D000328:Adult; D005002:Ethiopia; D005069:Evaluation Studies as Topic; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000150:complications*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D014944:World Health Organization
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