title: [Diagnostic strategies in the Tuberculosis Clinic of the Hospital General La Raza National Medical Center].
abstract: In order to diagnose TB infection, tuberculin skin test and interferon gamma release assay are available. The tuberculin test has a sensitivity of 99 % and a specificity of 95 %. For the detection of interferon gamma in blood there are currently two tests available: TBGold QuantiFERON-In-Tube (with a sensitivity of 0.70 and a specificity of 0.90), and T-SPOT-TB (sensitivity 0.90 and specificity 0.93). To diagnose the disease, a microscopy of direct smears for acid-fast bacilli is used if the physician is facing an extensive cavitary lung disease due to M. tuberculosis (this test has a high sensitivity: 80-90 %). The most common staining techniques used are Ziehl-Neelsen and Kinyoun, and the fluorescent technique, auramine-rhodamine. The culture is the gold standard and it has a sensitivity of 80 % and a specificity over 90 %, but the results take weeks. The nucleic acid amplification test has an overall sensitivity and specificity of 0.85 and 0.97, respectively. In the presence of a pleural effusion is necessary to perform a pleural biopsy for culture with a sensitivity of 85 % if it is percutaneous and 98 % if it was taken by thoracoscopy. The adenosine deaminase can be determined in pleural fluid with a sensitivity and specificity of 95 %.
authors.affiliation: Servicio de Neumología, Hospital General, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México. mksapmd@yahoo.com.mx.
authors.forename: Alberto Alejandro
authors.initials: AA
authors.lastname: Flores-Ibarra
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Ochoa-Vázquez
authors.forename: Georgina Alejandra
authors.initials: GA
authors.lastname: Sánchez-Tec
mesh_terms: D000465:Algorithms; D000066491:Clinical Decision-Making; D046508:Culture Techniques; D006769:Hospitals, General; D006801:Humans; D059425:Interferon-gamma Release Tests; D008800:Mexico; D010996:Pleural Effusion / Q000382:microbiology; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology
keywords: Diagnosis; Mycobacterium tuberculosis; Tuberculosis