Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting—General, Study Site, and Study Period
2.3. Study Population
2.4. Sources of Data
2.5. Data Collection and Validation
2.6. Data Variables
Definitions
2.7. Analysis and Statistics
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
Open Access Statement
References
- World Health Organization. Global Tuberculosis Report 2020; World Health Organization: Geneva, Switzerland, 2020; Available online: https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf (accessed on 16 December 2020).
- Steingart, K.R.; Henry, M.; Laal, S.; Hopewell, P.C.; Ramsay, A.; Menzies, D.; Cunningham, J.; Weldingh, K.; Pai, M. A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. Postgrad. Med. J. 2007, 83, 705–712. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vorster, M.J.; Allwood, B.W.; Diacon, A.H.; Koegelenberg, C.F.N. Tuberculous pleural effusions: Advances and controversies. J. Thorac. Dis. 2015, 7, 981–991. [Google Scholar] [CrossRef]
- Peto, H.M.; Pratt, R.H.; Harrington, T.A.; LoBue, P.A.; Armstrong, L.R. Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin. Infect. Dis. 2009, 49, 1350–1357. [Google Scholar] [CrossRef] [PubMed]
- Ruan, S.Y.; Chuang, Y.C.; Wang, J.Y.; Lin, J.W.; Chien, J.Y.; Huang, C.T.; Kuo, Y.W.; Lee, L.N.; Yu, C.J.J. Revisiting tuberculous pleurisy: Pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax 2012, 67, 822–827. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Light, R.W. Pleural Diseases, 6th ed.; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2013. [Google Scholar]
- Trajman, A.; Pai, M.; Dheda, K.; Van Zyl Smit, R.; Zwerling, A.A.; Joshi, R.; Kalantri, S.; Daley, P.; Menzies, D. Novel tests for diagnosing tuberculous pleural effusion: What works and what does not? Eur. Respir. J. 2008, 31, 1098–1106. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization (WHO). Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care, 2017; World Health Organization: Geneva, Switzerland, 2017. [Google Scholar]
- World Health Organization. WHO Consolidated Guidelines on Tuberculosis. Module 3: Diagnosis-Rapid Diagnostics for Tuberculosis Detection; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Sandgren, A.; Hollo, V.; van der Werf, M.J. Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Euro Surveill. 2013, 18, 20431. [Google Scholar] [CrossRef] [PubMed]
- Light, R.W. Tuberculous pleural effusion. Turk Toraks Derg. 2015, 16, 1–9. [Google Scholar] [CrossRef] [Green Version]
- United Nations Development Programme. About Uzbekistan. Available online: https://www.uz.undp.org/content/uzbekistan/en/home/countryinfo/ (accessed on 16 December 2020).
- World Health Organization. Definitions and Reporting Framework for Tuberculosis-2013 Revision (Updated Dec 2014 and Jan 2020) (WHO/HTM/TB/2013.2); World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Liang, Q.; Pang, Y.; Yang, Y.; Li, H.; Guo, C.; Yang, X.; Chen, X. An improved algorithm for rapid diagnosis of pleural tuberculosis from pleural effusion by combined testing with GeneXpert MTB/RIF and an anti-LAM antibody-based assay. BMC Infect. Dis. 2019, 19, 548. [Google Scholar] [CrossRef]
- Tyagi, S.; Sharma, N.; Tyagi, J.S.; Haldar, S. Challenges in pleural tuberculosis diagnosis: Existing reference standards and nucleic acid tests. Future Microbiol. 2017, 12, 1201–1218. [Google Scholar] [CrossRef]
- Porcel, J.M. Advances in the diagnosis of tuberculous pleuritis. Ann. Transl. Med. 2016, 4, 282. [Google Scholar] [CrossRef] [Green Version]
- Sahn, S.A.; Huggins, J.T.; San José, M.E.; Álvarez-Dobaño, J.M.; Valdés, L. Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone? Int. J. Tuberc. Lung Dis. 2013, 17, 787–793. [Google Scholar] [CrossRef]
- Valdés, L.; Pose, A.; San José, E.; Martínez Vázquez, J.M. Tuberculous pleural effusions. Eur. J. Intern. Med. 2003, 14, 77–88. [Google Scholar] [CrossRef]
- Rufai, S.B.; Singh, A.; Kumar, P.; Singh, J.; Singh, S. Performance of xpert MTB/RIF assay in diagnosis of pleural tuberculosis by use of pleural fluid samples. J. Clin. Microbiol. 2015, 53, 3636–3638. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Du, J.; Huang, Z.; Luo, Q.; Xiong, G.; Xu, X.; Li, W.; Liu, X.; Li, J. Rapid diagnosis of pleural tuberculosis by Xpert MTB/RIF assay using pleural biopsy and pleural fluid specimens. J. Res. Med. Sci. 2015, 20, 26–31. [Google Scholar] [PubMed]
- Kim, C.H.; Oh, H.G.; Lee, S.Y.; Lim, J.K.; Lee, Y.H.; Seo, H.; Yoo, S.S.; Lee, S.Y.; Cha, S.I.; Park, J.Y.; et al. Differential diagnosis between lymphoma-associated malignant pleural effusion and tuberculous pleural effusion. Ann. Transl. Med. 2019, 7, 373. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.; Lee, Y.D.; Lim, J.K.; Lee, D.H.; Yoo, S.S.; Lee, S.Y.; Cha, S.I.; Park, J.Y.; Kim, C.H. Predictive Factors and Treatment Outcomes of Tuberculous Pleural Effusion in Patients With Cancer and Pleural Effusion. Am. J. Med. Sci. 2017, 354, 125–130. [Google Scholar] [CrossRef]
- Zarić, B.; Kuruc, V.; Milovančev, A.; Markovic, M.; Šarčev, T.; Čanak, V.; Pavlović, S. Differential diagnosis of tuberculous and malignant pleural effusions: What is the role of adenosine deaminase? Lung 2008, 186, 233–240. [Google Scholar] [CrossRef]
- Macías, A.; Sánchez-Montalvá, A.; Salvador, F.; Villar, A.; Tórtola, T.; Saborit, N.; Molina, I. Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study. Int. J. Infect. Dis. 2019, 78, 34–38. [Google Scholar] [CrossRef] [Green Version]
- Sharma, S.K.; Solanki, R.; Mohan, A.; Jain, N.K.; Chauhan, L.S. Outcomes of category III DOTS treatment in immunocompetent patients with tuberculosis pleural effusion. Int. J. Tuberc. Lung Dis. 2012, 16, 1505–1509. [Google Scholar] [CrossRef]
- Azeez, A.; Ndege, J.; Mutambayi, R. Associated factors with unsuccessful tuberculosis treatment outcomes among tuberculosis/HIV coinfected patients with drug-resistant tuberculosis. Int. J. Mycobacteriol. 2018, 7, 347–354. [Google Scholar] [CrossRef]
- Chen, L.; Bao, D.; Gu, L.; Gu, Y.; Zhou, L.; Gao, Z.; Huang, Y. Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment. BMC Infect. Dis. 2018, 18, 295. [Google Scholar] [CrossRef] [Green Version]
- Porcel, J.M.; Azzopardi, M.; Koegelenberg, C.F.; Maldonado, F.; Rahman, N.M.; Lee, Y.C.G. The diagnosis of pleural effusions. Expert Rev. Respir. Med. 2015, 9, 801–815. [Google Scholar] [CrossRef]
Diagnostic Procedure | Total Tests | Confirmed Pleural TB Diagnosis | Confirmed Cancer Diagnosis | |
---|---|---|---|---|
n | n | (%) | ||
Bacteriological analysis | - | |||
Sputum smear microscopy for AFB | 186 | 1 | (0.5) | - |
Pleural fluid microscopy for AFB | 129 | 5 | (3.9) | - |
Mycobacterial culture of pleural fluid | 3 | 0 | (0.0) | - |
Xpert MTB/RIF (pleural fluid and/or sputum) | 170 | 20 | (11.8) | - |
Cytology of pleural fluid | 164 | 64 | (39.0) | 8 |
Histology of pleural biopsy | 26 | 16 | (61.5) | 8 |
Characteristics | Total | Successful Outcome | Unsuccessful Outcome | RR | 95% CI | p Value | |||
---|---|---|---|---|---|---|---|---|---|
n | % | n | (%) | n | (%) | ||||
Age group | |||||||||
<40 years | 86 | (57.7) | 79 | (91.9) | 7 | (8.1) | 1 | ||
40 years and over | 63 | (42.3) | 56 | (88.9) | 7 | (11.1) | 1.37 | (0.50–3.70) | 0.540 |
Gender | |||||||||
Male | 89 | (59.7) | 81 | (91.0) | 8 | (9.0) | 1 | ||
Female | 60 | (40.3) | 54 | (90.0) | 6 | (10.0) | 1.11 | (0.41–3.04) | 0.836 |
Region of referral | |||||||||
Tashkent city | 30 | (20.1) | 29 | (96.7) | 1 | (3.3) | |||
Tashkent region | 36 | (24.2) | 31 | (86.1) | 5 | (13.9) | |||
Other cities ^ | 83 | (55.7) | 75 | (90.4) | 8 | (9.6) | |||
Place of residence | |||||||||
Urban | 41 | (27.5) | 37 | (90.2) | 4 | (9.8) | 1 | ||
Rural | 108 | (72.5) | 98 | (90.7) | 10 | (9.3) | 0.95 | (0.32–2.86) | 0.926 |
Drug-resistance | |||||||||
Sensitive/not bac.confirmed | 143 | (96.0) | 131 | (91.6) | 12 | (8.4) | 1 | ||
Confirmed RR/MDR | 6 | (4.0) | 4 | (66.7) | 2 | (33.3) | 3.97 | (1.13–13.93) | 0.031 |
Smoking | |||||||||
Yes | 37 | (24.8) | 35 | (94.6) | 2 | (5.4) | 1.98 | (0.46–8.45) | 0.355 |
No | 112 | (75.2) | 100 | (89.2) | 12 | (10.7) | 1 | ||
Alcohol use | |||||||||
Yes | 9 | (6.0) | 9 | (100.0) | 0 | (0.0) | |||
No | 140 | (94.0) | 126 | (90.0) | 14 | (10.0) | |||
HIV | |||||||||
Yes | 3 | (2.0) | 2 | (66.7) | 1 | (33.3) | 0.27 | (0.05–1.44) | 0.124 |
No | 146 | (98.0) | 133 | (91.1) | 13 | (8.9) | |||
Diabetes | |||||||||
Yes | 3 | (2.0) | 2 | (66.7) | 1 | (33.3) | 3.74 | (0.70–20.13) | 0.124 |
No | 146 | (98.0) | 133 | (91.1) | 13 | (8.9) | |||
Hepatitis | |||||||||
Yes | 5 | (3.4) | 3 | (60.0) | 2 | (40.0) | 4.80 | (1.44–15.98) | 0.011 |
No | 144 | (96.6) | 132 | (91.7) | 12 | (8.3) | 1 | ||
Other comorbidities * | |||||||||
Yes | 19 | (12.8) | 16 | (84.2) | 3 | (15.8) | 1.87 | (0.57–6.09) | 0.301 |
No | 130 | (87.2) | 119 | (91.5) | 11 | (8.5) | 1 |
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Abdugapparov, F.; Grigoryan, R.; Parpieva, N.; Massavirov, S.; Riskiyev, A.; Gadoev, J.; Buziashvili, M.; Tukvadze, N.; Hovhannesyan, A.; Dadu, A. Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan. Int. J. Environ. Res. Public Health 2021, 18, 5769. https://doi.org/10.3390/ijerph18115769
Abdugapparov F, Grigoryan R, Parpieva N, Massavirov S, Riskiyev A, Gadoev J, Buziashvili M, Tukvadze N, Hovhannesyan A, Dadu A. Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan. International Journal of Environmental Research and Public Health. 2021; 18(11):5769. https://doi.org/10.3390/ijerph18115769
Chicago/Turabian StyleAbdugapparov, Fazlkhan, Ruzanna Grigoryan, Nargiza Parpieva, Sherali Massavirov, Anvar Riskiyev, Jamshid Gadoev, Mariana Buziashvili, Nestani Tukvadze, Arax Hovhannesyan, and Andrei Dadu. 2021. "Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan" International Journal of Environmental Research and Public Health 18, no. 11: 5769. https://doi.org/10.3390/ijerph18115769
APA StyleAbdugapparov, F., Grigoryan, R., Parpieva, N., Massavirov, S., Riskiyev, A., Gadoev, J., Buziashvili, M., Tukvadze, N., Hovhannesyan, A., & Dadu, A. (2021). Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan. International Journal of Environmental Research and Public Health, 18(11), 5769. https://doi.org/10.3390/ijerph18115769