Nucleic acid amplification tests reduce delayed diagnosis and misdiagnosis of pulmonary tuberculosis

Jia-Yih Feng; Chou-Jui Lin; Jann-Yuan Wang; Shun-Tien Chien; Chih-Bin Lin; Wei-Chang Huang; Chih-Hsin Lee; Chin-Chung Shu; Ming-Chih Yu; Jen-Jyh Lee; Chen-Yuan Chiang

doi:10.1038/s41598-022-16319-8

Nucleic acid amplification tests reduce delayed diagnosis and misdiagnosis of pulmonary tuberculosis

Sci Rep. 2022 Jul 14;12(1):12064. doi: 10.1038/s41598-022-16319-8.

Authors

Jia-Yih Feng^{1

2

3}, Chou-Jui Lin⁴, Jann-Yuan Wang^{5

6}, Shun-Tien Chien⁷, Chih-Bin Lin^{8

9}, Wei-Chang Huang^{10

11

12

13}, Chih-Hsin Lee^{14

15}, Chin-Chung Shu⁵, Ming-Chih Yu^{14

15

16}, Jen-Jyh Lee⁸, Chen-Yuan Chiang^{17

18

19}

Affiliations

¹ Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
³ Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
⁴ Tao-Yuan General Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan, ROC.
⁵ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
⁶ School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
⁷ Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan, ROC.
⁸ Division of Chest Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan, ROC.
⁹ School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
¹⁰ Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
¹¹ Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
¹² Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC.
¹³ Master Program for Health Administration, Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC.
¹⁴ Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC.
¹⁵ Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 111 Hsin-Long Road, Section 3, Taipei 116, Taiwan, ROC.
¹⁶ School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
¹⁷ Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC. cychiang@tmu.edu.tw.
¹⁸ Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 111 Hsin-Long Road, Section 3, Taipei 116, Taiwan, ROC. cychiang@tmu.edu.tw.
¹⁹ International Union Against Tuberculosis and Lung Disease, Paris, France. cychiang@tmu.edu.tw.

Abstract

The clinical impact of nucleic acid amplification (NAA) tests on reducing delayed diagnosis and misdiagnosis of pulmonary TB (PTB) has rarely been investigated. PTB patients were classified into a frontline NAA group, an add-on NAA group, and a no NAA group. The outcomes of interest were the proportion of PTB case died before anti-TB treatment, the interval between sputum examination and initiation of treatment, and misdiagnosis of PTB. A total of 2192 PTB patients were enrolled, including 282 with frontline NAA, 717 with add-on NAA, and 1193 with no NAA tests. Patients with NAA tests had a lower death rate before treatment initiation compared to those without NAA tests (1.6% vs. 4.4%, p < 0.001) in all cases. Patients with frontline NAA compared to those with add-on NAA and those without NAA, had a shorter interval between sputum examination and treatment initiation in all cases (3 days vs. 6 days (p < 0.001), vs 18 days (p < 0.001)), and less misdiagnosis in smear-positive cases (1.8% vs. 5.6% (p = 0.039), vs 6.5% (p = 0.026)). In conclusion, NAA tests help prevent death before treatment initiation. Frontline NAA tests perform better than add-on NAA and no NAA in avoiding treatment delay in all cases, and misdiagnosis of PTB in smear-positive cases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delayed Diagnosis
Diagnostic Errors
Humans
Mycobacterium tuberculosis* / genetics
Nucleic Acid Amplification Techniques
Sputum
Tuberculosis, Pulmonary* / diagnosis
Tuberculosis, Pulmonary* / drug therapy