An Evaluation of The Diagnostic Value of Sputum Smears Microscopy and Pcr Relative to Sputum Culture in The Diagnosis of Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis in Iran

Shoboo Rahmati; Abbas Bahrampour; Mahshid Nasehi; Ali Mirzazadeh; Hosna Ghaderi; Armita Shahesmaeili

doi:10.47176/mjiri.36.112

An Evaluation of The Diagnostic Value of Sputum Smears Microscopy and Pcr Relative to Sputum Culture in The Diagnosis of Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis in Iran

Med J Islam Repub Iran. 2022 Sep 27:36:112. doi: 10.47176/mjiri.36.112. eCollection 2022.

Authors

Shoboo Rahmati¹, Abbas Bahrampour², Mahshid Nasehi³, Ali Mirzazadeh⁴, Hosna Ghaderi⁵, Armita Shahesmaeili⁶

Affiliations

¹ Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.
² Modeling in Health Research Center, Institute for Futures Studies in Health, Department of Biostatistics and Epidemiology, Faculty of Health Kerman University of Medical Sciences, Kerman, IRAN. Adjunct Professor of Griffith University, Brisbane, QLD, Australia.
³ Department of Epidemiology, School of Health, Iran University of Medical Sciences, Iran.
⁴ Department of Epidemiology, University of San Francisco, California, USA.
⁵ Department of Laboratory Sciences, Faculty of Paramedical, Kurdistan University of Medical Sciences, Kurdistan, Iran.
⁶ HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Abstract

Background: Tuberculosis is one of the oldest known diseases in humans, and early detection of tuberculosis is one of the main measures to decrease the spread of tuberculosis. In many parts of the world, including Iran, the diagnosis of tuberculosis is based on the detection of acid-fast bacillus in sputum smear microscopy and PCR. this study aimed to synthesize evidence on the diagnostic accuracy of sputum smear and PCR compared to sputum culture for the diagnosis of PT in Iranian patients. Methods: This systematic review and meta-analysis was conducted based on PRISMA guideline for systematic review and meta-analysis. Eligible studies were cross-sectional original diagnostic studies published in English and Persian in Iran which examined the sensitivity or specificity(study outcome) of sputum smear microscopy or PCR( as the test) relative to sputum culture (as the gold standard/comparator) among Iranian patients suspected of having tuberculosis( study population). Studies whose data were not complete or extractable were excluded. Results: A total of 3518 subjects were evaluated from 15 eligible studies. The pooled sensitivity of sputum smear and PCR was 75.12 (95% CI: 66.68-83.56) and 88.02 (95% CI: 82.87-93.27), respectively. The specificity for sputum smear and PCR was 93.94 (95% CI: 91.26-96.63) and 91.82 (95% CI: 87.29-96.35) respectively. The sensitivity of both sputum smears was higher in studies published after 2010, and had higher quality. The specificity of sputum smear was a bit lower in studies published after2010 but higher in studies with higher quality. The specificity of PCR was higher in studies published after 2010 but higher in studies with higher quality. Conclusion:The increased sensitivity of sputum smear and PCR during recent years suggests the improvement of preparation and laboratory methods in recent years. However, the imperfect sensitivity of these tests highlights the need for a more accurate diagnostic method for the detection of pulmonary tuberculosis in Iran.

Keywords: Iran; Meta-Analysis; Mycobacterium tuberculosis; Polymerase Chain Reaction; Sputum Culture; Sputum Smear.

Publication types

Review