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Open Access Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

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Setting: Adult pulmonary tuberculosis (TB) patients unable to expectorate quality sputum represent a diagnostic challenge. A private hospital in Pakistan routinely performs gastric aspiration in adults with difficulties expectorating.

Objective: To assess the usefulness of gastric specimens (GS) in diagnosing pulmonary TB (PTB) and drug-resistant TB in adult presumptive TB patients unable to expectorate, and to compare the diagnostic yield and sensitivity of smear, culture and the Xpert® MTB/RIF assay.

Design: This was a comparative cross-sectional study based on retrospective record review.

Results: Of 900, 885 and 877 GS tested by smear, Xpert and culture, respectively, interpretable results were obtained for respectively 900 (100%), 859 (97.1%) and 754 (86.0%), with a diagnostic yield of respectively 23.6%, 30.3% and 24.9%. The yield was significantly higher for Xpert in previously treated patients. There were 313 patients with definite TB, defined as positive on Xpert and/or culture. The 82.8% sensitivity of Xpert was significantly higher than that of smear (61.0%) and culture (67.8%).

Conclusion: GS obtained by aspiration under routine programme conditions is useful for detecting TB and drug-resistant TB in adult patients unable to expectorate. Xpert, with its rapid testing, high proportion of interpretable results and better sensitivity, can substantially improve the diagnosis of bacteriologically confirmed TB and rifampicin resistance.

Keywords: Xpert® MTB/RIF; adult pulmonary TB; gastric specimen

Document Type: Research Article

Affiliations: 1: National Tuberculosis Reference Laboratory, National Tuberculosis Control Program (NTP), Islamabad, Pakistan 2: Rawalpindi Leprosy Hospital, Rawalpindi, Pakistan 3: NTP, Islamabad, Pakistan 4: Pakistan Institute of Medical Sciences, Islamabad, Pakistan 5: Independent Tuberculosis Consultant, Oslo, Norway

Publication date: 21 June 2017

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

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