{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T16:44:40Z","timestamp":1770223480641,"version":"3.49.0"},"reference-count":29,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,2]]},"abstract":"<jats:p>Human immunodeficiency virus (HIV) infection is a major risk factor for the development of active tuberculosis (TB), one of the deadliest infectious diseases globally. The high mortality associated with the disease can be reduced by early diagnosis and prompt antituberculous treatment initiation. Facilities in TB-endemic regions are increasing the use of nucleic acid amplification (e.g., GeneXpert), which provides rapid results but may have suboptimal sensitivity in HIV-associated TB. Our objective was to evaluate the current practices for TB diagnosis at Edendale Hospital, a large regional hospital in KwaZulu-Natal, South Africa\u2014a TB-endemic region with high HIV prevalence. In this cross-sectional study, all adult inpatients newly started on TB treatment at Edendale were identified over a 6-week period. Demographics, clinical information, diagnostic test results, and outcomes were documented. Pulmonary TB (PTB), extrapulmonary TB (EXTB), and PTB + EXTB were defined as disease evidence in the lungs, other organs, or both, respectively. Ninety-four cases were identified, of which 83% were HIV-associated. Only 30% of all TB patients were microbiologically confirmed, consisting of 7\/16 (44%) HIV-uninfected and 21\/78 (27%) HIV-infected TB patients. Smear microscopy and mycobacterial culture were seldom ordered. Ultrasound was performed in about one-third of suspected EXTB cases and was valuable in identifying abdominal TB. In this clinical setting with a high incidence of HIV-associated TB, TB diagnosis was more commonly based on clinical assessment and imaging results than on mycobacterial gold standard test confirmation.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0965","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T07:00:21Z","timestamp":1528786821000},"page":"317-322","source":"Crossref","is-referenced-by-count":6,"title":["Utilization and Clinical Value of Diagnostic Modalities for Tuberculosis in a High HIV Prevalence Setting"],"prefix":"10.4269","volume":"99","author":[{"given":"Stephanie","family":"Gati","sequence":"first","affiliation":[{"name":"Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhoda","family":"Chetty","sequence":"additional","affiliation":[{"name":"Department of Medicine, Edendale Hospital, University of KwaZulu-Natal, KwaZulu-Natal, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Edendale Hospital, University of KwaZulu-Natal, KwaZulu-Natal, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline M.","family":"Achkar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albert Einstein College of Medicine, Bronx, New York;"},{"name":"Department of Microbiology, Albert Einstein College of Medicine, Bronx, New York;"},{"name":"Department of Immunology, Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","author":"WHO","year":"2017"},{"key":"b2","series-title":"J Infect Dis","first-page":"1146","article-title":"Virological and immunological impact of tuberculosis on human immunodeficiency virus type 1 disease","volume":"188","author":"Toossi","year":"2003"},{"key":"b3","series-title":"J Infect Dis","first-page":"S15","article-title":"Facing the crisis: improving the diagnosis of tuberculosis in the HIV era","volume":"196","author":"Perkins","year":"2007"},{"key":"b4","series-title":"Arch Intern Med","first-page":"1009","article-title":"The growing burden of tuberculosis: global trends and interactions with the HIV epidemic","volume":"163","author":"Corbett","year":"2003"},{"key":"b5","author":"WHO","year":"2013"},{"key":"b6","series-title":"Microbes Infect","first-page":"635","article-title":"Tuberculosis unleashed: the impact of human immunodeficiency virus infection on the host granulomatous response to Mycobacterium tuberculosis","volume":"4","author":"Lawn","year":"2002"},{"key":"b7","series-title":"Tuber Lung Dis","first-page":"244","article-title":"Comparative histopathological study of pulmonary tuberculosis in human immunodeficiency virus-infected and non-infected patients","volume":"77","author":"Di Perri","year":"1996"},{"key":"b8","series-title":"Am Rev Respir Dis","first-page":"1292","article-title":"Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection","volume":"148","author":"Jones","year":"1993"},{"key":"b9","series-title":"Southeast Asian J Trop Med Public Health","first-page":"140","article-title":"Clinical presentations and outcomes of TB among HIV-positive patients","volume":"31","author":"Poprawski","year":"2000"},{"key":"b10","series-title":"Lung","first-page":"27","article-title":"Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis","volume":"191","author":"Naing","year":"2013"},{"key":"b11","series-title":"J Infect Dis","first-page":"S29","article-title":"Defining the needs for next generation assays for tuberculosis","volume":"211","author":"Denkinger","year":"2015"},{"key":"b12","series-title":"Cochrane Database Syst Rev","first-page":"CD009593","article-title":"Xpert\u00ae MTB\/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults","volume":"1","author":"Steingart","year":"2014"},{"key":"b13","series-title":"BMC Infect Dis","first-page":"709","article-title":"Diagnostic accuracy of the Xpert MTB\/RIF assay for extrapulmonary and pulmonary tuberculosis when testing non-respiratory samples: a systematic review","volume":"14","author":"Maynard-Smith","year":"2014"},{"key":"b14","series-title":"J Acquir Immune Defic Syndr","first-page":"500","article-title":"Performance of abdominal ultrasound for diagnosis of tuberculosis in HIV-infected persons living in Cambodia","volume":"55","author":"Sculier","year":"2010"},{"key":"b15","series-title":"Int J Infect Dis","first-page":"e108","article-title":"Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa","volume":"14","author":"Heller","year":"2010"},{"key":"b16","author":"Massyn","year":"2016"},{"key":"b17","author":"WHO","year":"2007"},{"key":"b18","series-title":"Sci Rep","first-page":"19391","article-title":"Assessing the utility of Xpert(\u00ae) MTB\/RIF as a screening tool for patients admitted to medical wards in South Africa","volume":"6","author":"Heidebrecht","year":"2016"},{"key":"b19","series-title":"Trans R Soc Trop Med Hyg","first-page":"305","article-title":"Policy to practice: impact of GeneXpert MTB\/RIF implementation on the TB spectrum of care in Lilongwe, Malawi","volume":"110","author":"Chawla","year":"2016"},{"key":"b20","series-title":"Int J Tuberc Lung Dis","first-page":"368","article-title":"Point-of-care Xpert\u00ae MTB\/RIF for smear-negative tuberculosis suspects at a primary care clinic in South Africa","volume":"17","author":"Van Rie","year":"2013"},{"key":"b21","series-title":"PLoS One","first-page":"e65421","article-title":"Time to treatment and patient outcomes among TB suspects screened by a single point-of-care xpert MTB\/RIF at a primary care clinic in Johannesburg, South Africa","volume":"8","author":"Hanrahan","year":"2013"},{"key":"b22","series-title":"PLoS Med","first-page":"e1001061","article-title":"Comparison of Xpert MTB\/RIF with other nucleic acid technologies for diagnosing pulmonary tuberculosis in a high HIV prevalence setting: a prospective study","volume":"8","author":"Scott","year":"2011"},{"key":"b23","series-title":"Am J Respir Crit Care Med","first-page":"132","article-title":"Evaluation of the Xpert MTB\/RIF assay for the diagnosis of pulmonary tuberculosis in a high HIV prevalence setting","volume":"184","author":"Theron","year":"2011"},{"key":"b24","series-title":"J Infect Dis","first-page":"S1179","article-title":"Incipient and subclinical tuberculosis: defining early disease states in the context of host immune response","volume":"204","author":"Achkar","year":"2011"},{"key":"b25","series-title":"PLoS One","first-page":"e0180572","article-title":"Sputum quality and diagnostic performance of GeneXpert MTB\/RIF among smear-negative adults with presumed tuberculosis in Uganda","volume":"12","author":"Meyer","year":"2017"},{"key":"b26","series-title":"Int J Tuberc Lung Dis","first-page":"216","article-title":"Chest X-ray vs. Xpert\u00ae MTB\/RIF assay for the diagnosis of sputum smear-negative tuberculosis in Uganda","volume":"18","author":"Wekesa","year":"2014"},{"key":"b27","author":"WHO","year":"2015"},{"key":"b28","series-title":"BMC Med","first-page":"67","article-title":"Diagnostic accuracy, incremental yield and prognostic value of Determine TB-LAM for routine diagnostic testing for tuberculosis in HIV-infected patients requiring acute hospital admission in South Africa: a prospective cohort","volume":"15","author":"Lawn","year":"2017"},{"key":"b29","series-title":"Sci Rep","first-page":"10931","article-title":"Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays","volume":"7","author":"Kerkhoff","year":"2017"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/2\/article-p317.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/2\/article-p317.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/2\/article-p317.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T19:30:00Z","timestamp":1722454200000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/2\/article-p317.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,2]]},"references-count":29,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0965","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,2]]}}}