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Chest Infections |

Clinical Accuracy of Real Time PCR for the Diagnosis of Pulmonary Tuberculosis

Jung Hyun Chang*, PhD; Seo Woo Kim, BS; Seok Jeong Lee, BS; Jin Hwa Lee, PhD; Yon Ju Ryu, PhD
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Ewha Womans University, Seoul, Republic of Korea


Chest. 2012;142(4_MeetingAbstracts):203A. doi:10.1378/chest.1389472
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Abstract

SESSION TYPE: Respiratory Infections Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The incidence of tuberculosis in Korea is still high among OECD nations as 74.3/100,000 in 2010, although it has a declining tendency. AFB smear test has low sensitivity in the diagnosis of tuberculosis and AFB culture has a disadvantage of taking time. Real time PCR has been introduced for rapid diagnosis and differential diagnosis with nontuberculous mycobacterium. This study was designed to evaluate the clinical accuracy of real time PCR in the specimen of sputum and/or bronchoscopic aspirates.

METHODS: The 3525 patients who took sputum PCR and/or bronchoscopic PCR were reviewed retrospectively from Mar, 2006 to Sept, 2011 in Ewha Medical Center, Seoul, Korea. In all cases, AFB smear and culture were examined together in all cases. The diagnosis of tuberculosis was defined positive for tuberculosis microbiologically, pathologic finding of tuberculosis in lung and pleura, or clinical decision of active tuberculosis following anti-tuberculous medication more than 6 months. Finally 3501 subjects were included excluding 24 subjects due to insufficient observational period.

RESULTS: In sputum PCR, sensitivity was 45% (272 among 607 cases of tuberculosis diagnosis); specificity 99.6% (1936/1944); accuracy 87% (272+1936)/2551. In bronchoscopic PCR, sensitivity was 64% (319 among 496 cases of tuberculosis diagnosis); specificity 98% (1143/1171); accuracy 88% (319+1143)/1667. In total cases of sputum and/or bronchoscopic samples, sensitivity was 59% (498/838), specificity was 99% (2629/2663), and finally accuracy was increased to 89% (498+2629)/3501.

CONCLUSIONS: The positivity of PCR in sputum or bronchoscopic specimen suggests high probability of tuberculosis in clinically suspected cases.

CLINICAL IMPLICATIONS: In case of positivity in real time PCR, the patient should be evaluated further for active tuberculosis and considered to start anti-tuberculous medication.

DISCLOSURE: The following authors have nothing to disclose: Jung Hyun Chang, Seo Woo Kim, Seok Jeong Lee, Jin Hwa Lee, Yon Ju Ryu

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Ewha Womans University, Seoul, Republic of Korea

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