Please use this identifier to cite or link to this item: https://ninho.inca.gov.br/jspui/handle/123456789/12682
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dc.contributor.authorGuerra, Renata Leborato-
dc.contributor.authorHooper, Nancy M.-
dc.contributor.authorBaker, James F.-
dc.contributor.authorAlborz, Roya-
dc.contributor.authorArmstrong, Derek T.-
dc.contributor.authorMaltas, Gina-
dc.contributor.authorKiehlbauch, Julia A.-
dc.contributor.authorDorman, Susan E.-
dc.date.accessioned2023-02-09T18:21:18Z-
dc.date.available2023-02-09T18:21:18Z-
dc.date.issued2007-09-
dc.identifier.issn1931-3543-
dc.identifier.urihttps://ninho.inca.gov.br/jspui/handle/123456789/12682-
dc.description.abstractThe Amplified Mycobacterium tuberculosis Direct Test (MTD; Gen-Probe; San Diego, CA) is a nucleic-acid amplification test for rapid pulmonary tuberculosis (PTB) diagnosis. In a routine public health setting, test accuracy and impact on clinical decisions are unknown. Methods: Retrospectively, we evaluated MTD accuracy and impact on clinical decisions in a public health setting. To estimate MTD accuracy, mycobacterial culture was used as the “gold standard.” To evaluate MTD impact on clinical decisions, concordance of clinician presumptive diagnosis (at time of MTD and smear availability) and definitive diagnosis, and duration of nonindicated tuberculosis therapy were determined for smear-positive PTB suspects in a period of MTD availability (MTD group) and a prior period of MTD nonavailability (non-MTD group). Results: A total of 1,151 respiratory specimens from 638 PTB suspects were analyzed. MTD sensitivity, specificity, positive predictive value, and negative predictive value were 91.7%, 98.7%, 96.7%, and 96.5% overall, respectively; and 98.7%, 97.8%, 98.7%, and 97.8% for smear-positive patients; and 62.2%, 98.9%, 85.2%, and 96.1% for smear-negative patients. In the MTD group, concordance between definitive and clinician presumptive diagnoses was 78% (95% confidence interval [CI], 64 to 88%), similar to that for the non-MTD group (79%; 95% CI, 68.4 to 89.6%). However, concordance between definitive diagnosis and the MTD test was 98% (95% CI, 94.1 to 100%). Median duration of nonindicated tuberculosis treatment was 6 days for the MTD group vs 31 days for the non-MTD group (p � 0.002). Conclusion: In this public health setting, MTD was accurate and rapidly detected more than half of the smear-negative PTB cases. For smear-positive PTB suspects, MTD had excellent concor dance with definitive diagnosis, but clinicians often inappropriately initiated TB therapy despite a negative MTD result.pt_BR
dc.publisherChestpt_BR
dc.subjectMycobacterium tuberculosispt_BR
dc.subjectTuberculinapt_BR
dc.subjectTuberculinpt_BR
dc.subjectDiagnósticopt_BR
dc.subjectdiagnosispt_BR
dc.subjectMecânica Respiratóriapt_BR
dc.subjectRespiratory Mechanicspt_BR
dc.subjectManejo de Espécimespt_BR
dc.subjectSpecimen Handlingpt_BR
dc.subjectTuberculosept_BR
dc.subjectTuberculosispt_BR
dc.subjectTécnica de Amplificação ao Acaso de DNA Polimórficopt_BR
dc.subjectRandom Amplified Polymorphic DNA Techniquept_BR
dc.titleUse of the amplified mycobacterium tuberculosis direct test in a public health laboratory: test performance and impact on clinical carept_BR
dc.TypeArticlept_BR
Appears in Collections:Artigos de Periódicos da área de Pesquisa Populacional



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