TAILIEUCHUNG - Accuracy of Clinical Signs in the Diagnosis of Pulmonary Tuberculosis: Comparison of Three Reference Standards Using Data from a Tertiary Care Centre in Rwanda

Our study shows that, in spite of a gradual decrease, the incidence rates of pulmonary tuberculosis in immigrants remain high even a decade after immigration. The persistent high incidence rates are consistent with results of previous studies (2–5). Our study combines data on all immigrant patients in whom tuberculosis was detected and all legal immigrants present in a 5-year period in a low incidence country, enabling detailed analysis with a long follow-up period. We did not find a steep decline in incidence rates after immigration. One might anticipate such a decline, since the proportion of recently infected or reinfected persons will be higher sooner after immigration than later due to relatively low levels. | The Open Tropical Medicine Journal 2008 1 1-7 1 Accuracy of Clinical Signs in the Diagnosis of Pulmonary Tuberculosis Comparison of Three Reference Standards Using Data from a Tertiary Care Centre in Rwanda Mugabekazi Julie1 Boelaert Marleen2 Sarushi Joseph1 Seruyange Eric1 Basinga Paulin3 Musemakweli André4 Van der Stuyft Patrick2 Bisoffi Zeno5 Moreira Juan1 Van Den Ende Jef1 2 Centre Hospitalier de Kigali Rwanda 2Institute of Tropical Medicine Antwerp Belgium 3School of Public Health National University of Rwanda 4National University of Rwanda and 5Centro per le Malattie Tropicali Negrar Verona Italy Abstract Objective To determine the prevalence of TB and the diagnostic sensitivity and specificity of major disease characteristics in a tertiary hospital setting in Rwanda relative to three reference standards. Study Design and Setting A prospective study was conducted in which 300 consecutive patients with cough of at least 2-weeks duration were evaluated at a tertiary healthcare facility. We compared the estimates of TB prevalence and the diagnostic accuracy of fever haemoptysis sputum smear microscopy radiological signs and HIV infection as generated by a latent class analysis LCA with those given by culture and by a composite reference standard CRS which relied on bacteriological confirmation and or cavities. Results LCA estimated the prevalence of TB at 44 . The most sensitive characteristics were fever 90 and HIV infection 86 but both lacked specificity. The most specific characteristics were microscopy 99 X-Ray cavities 97 and apical infiltrates 93 . When culture was taken as a reference standard the prevalence was 38 for the CRS it was 45 . For both the diagnostic sensitivity and specificity were comparable to those obtained with LCA. Conclusion Three reference standards produced comparable diagnostic sensitivities and specificities using major symptoms and signs of pulmonary TB only LCA allowed estimating the diagnostic characteristics of culture. Both LCA

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