Tuberc Respir Dis.  2015 Jan;78(1):1-7. 10.4046/trd.2015.78.1.1.

The Effectiveness of Real-Time PCR Assay, Compared with Microbiologic Results for the Diagnosis of Pulmonary Tuberculosis

• Kim SW
• Kim SI
• Lee SJ
• Lee JH
• Ryu YJ
• Shim SS
• Kim Y
• Lee MA
• Chang JH

• KMID: 2114642
• DOI: http://doi.org/10.4046/trd.2015.78.1.1

Abstract

BACKGROUND
The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting.
METHODS
Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response.
RESULTS
Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%.
CONCLUSION
Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.

Keyword

Diagnosis; Sputum; Bronchoscopy; Real-Time Polymerase Chain Reaction; Tuberculosis, Pulmonary

MeSH Terms

Bronchoscopy
Diagnosis*
Incidence
Korea
Lung
Pleura
Prevalence
Real-Time Polymerase Chain Reaction*
Retrospective Studies
Sputum
Tuberculosis
Tuberculosis, Pulmonary*

Figure

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  Figure 1 Sensitivity, specificity, and accuracy of real-time polymerase chain reaction with sputum or bronchoscopic aspirate for the detection of Mycobacterium tuberculosis.

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