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Chest Infections |

Could We Avoid Ulysses Syndrome in the Diagnosis of Tuberculosis Disease Based on IGRA Testing?

Oana Arghir, PhD; Ioan Arghir, MS; Paraschiva Postolache, PhD; Elena Dantes, PhD; Simona Cambrea, PhD
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Faculty of Medicine Ovidius University, Constanta, Romania


Chest. 2014;145(3_MeetingAbstracts):139A. doi:10.1378/chest.1825917
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Abstract

SESSION TITLE: Tuberculosis Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To evaluate the impact of QuantiFERON TB Gold In Tube test as a false-positive laboratory result in the diagnosis of Tuberculosis Disease (TB) across south eastern Romania; a TB burden area.

METHODS: Stedman's Medical Dictionary definition describes "Ulysses syndrome" as "the effects of an intensive and prolonged medical intervention came as a result of a false-positive laboratory result or misinterpreted during routine investigations".A prospective study between 01.01.2008 to 31.05.2012 was conducted in the Clinical Pulmonology Hospital of Constanta, Romania, in order to asses the value of QuantiFERON (QTF) TB Gold In Tube (GIT) in the diagnosis of Tuberculosis (TB) active disease. Study population consisted of 279 inpatients with negative smears, but sugestive symptoms and/or chest X-ray for a Postprimary Pulmonary Tuberculosis (PTB) Disease. All patients inform consented to be screened.

RESULTS: More than half of the study population had negative QuantiFERON GIT test results (n1= 162; 58%). Among those patients with positive QTF GIT results (n2= 65/117;55.5%), IGRA tests were corelated with positive cultures for Mycobacterium tuberculosis (57) or sugestive histopathological exam (8). Misdiagnosis of TB was determined in 16.6% of QTF GIT negative cases (n1= 27/162) through positive MTB cultures (24) or histopathogically (3). TB first regimen of therapy (DOTS) was stopped in 52 positive QTF GIT inpatients after 2 months of daily administration and started in 27 QTF GIT negative ones with a delay of 2 months. The impact of Ulysses syndrome is significantly associated with QTF GIT in misdiagnosing a third of TB disease's cases [n1=27 and n2=52; OR= 4 (2.23<OR<7.21); RR= 2.67 (1.79<RR<3.98); CI=95%; χ2= 25.73; p<0.000].

CONCLUSIONS: The effects of DOTS as an intensive and prolonged medical intervention came as a result of the false-positive QTF GIT laboratory. Ulysses Syndrome based on IGRA test is dificult to be avoided in negative smears Pulmonary TB disease.

CLINICAL IMPLICATIONS: A negative QuantiFERON TB Gold In Tube test result does not exclude the TB disease diagnosis and a positive result may not absolutely confirm it.

DISCLOSURE: The following authors have nothing to disclose: Oana Arghir, Ioan Arghir, Paraschiva Postolache, Elena Dantes, Simona Cambrea

No Product/Research Disclosure Information


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