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EXAMINATION OF RESPIRATORY SPECIMENS IMPROVES MICROBIOLOGICAL DIAGNOSIS OF PATIENTS WITH PRESUMPTIVE EXTRAPULMONARY TUBERCULOSIS
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Abstract
Bacteriological confirmation of extrapulmonary tuberculosis (EPTB) is challenging for several
reasons: the paucibacillary nature of the sample; scarce resources, mainly in middle and low-income
countries; the need for hospitalization; and unfavorable outcomes. We evaluated the diagnostic role of
respiratory specimen examination prospectively in a cohort of patients with presumptive EPTB.
Methods: From July 2018 to January 2019, in a tuberculosis (TB)/HIV reference hospital, a cohort of 157
patients with presumed EPTB was evaluated. Xpert1 MTB/RIF Ultra or a culture-positive result was
considered for bacteriologically confirmed TB.
Results: Out of 157 patients with presumptive EPTB, 97 (62%) provided extrapulmonary and respiratory
specimens and 60 (38%) extrapulmonary specimens only. Of the 60 patients with extrapulmonary
samples, 5 (8%) were positive. Of those with respiratory and extrapulmonary samples, 27 (28%) were
positive: 10 in both the respiratory and extrapulmonary samples, 6 in the extrapulmonary sample only,
and 11 in the respiratory sample only. A respiratory specimen examination increased by 6-fold the chance
of bacteriological confirmation of TB (odds ratio = 5.97 [1.11–47.17]).
Conclusion: We conclude that respiratory samples should be examined in patients with presumptive EPTB.
© 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-
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