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Clinical Use of Nucleic-Acid-Amplification Tests

Vu-Dinh Minh, MD, FCCP; Le-Quoc Hanh, MD; Mai Vu, MPH
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Affiliations: Los Angeles, CA 
 ,  Dr. Minh is Physician Specialist at Los Angeles County Public Health. Dr. Hanh is Associate Director of Los Angeles County TB control. Ms. Vu is Juris Doctor candidate at Hastings Law School.

Correspondence to: Vu-Dinh Minh, MD, FCCP, South Health Center, 1522 East 102nd St, Los Angeles, CA 90002; e-mail:vminh@dhs.co.la.ca.us



Chest. 2000;118(3):574-575. doi:10.1378/chest.118.3.574
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Since Koch’s discovery of the bacillar etiology of tuberculosis (TB), diagnosis of the disease by the conventional smear/culture method has remained essentially unchanged. Smears detected the acid-fast bacillus (AFB), and cultures determined whether the AFB detected was a mycobacterium TB (MTB). Innovation amounted to a few new smear stains and an array of diversified culture media.

The method left much to be desired. Smears missed about 50% of culture-proven cases, and could not differentiate MTB from other mycobacteria (MOTT). The more sensitive and specific cultures detected up to 80% of active cases, but took 2 to 8 weeks for completion. Without an immediate diagnosis, the clinician had to prescribe in full the four-drug regimen to all suspected TB patients for up to 2 months. Considering that only one of five or six of these patients finally qualified for class III (having active disease), there was a fivefold to sixfold waste of public health resources during the first 2 months of all treatments. For the unnecessarily treated, personal damage could be heavy in terms of drug side effects, loss of work, and the potential humiliation from different public health interventions (directly observed therapy, isolation, contact investigation, etc) that any unskillful handling by public health staff could turn into harassment and violation of patients’ rights.

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