Outcomes of HIV-positive patients with non-tuberculous mycobacteria positive culture who received anti-tuberculous treatment in Botswana: Implications of using diagnostic algorithms without non-tuberculous mycobacteria

• DOI: 10.1371/journal.pone.0234646
• Publication Date: 2020-06-12T17:27:01Z
• Authors: Tefera Agizew; Rosanna Boyd; Unami Mathebula; Anikie Mathoma; Joyce Basotli; Christipher Serumola; Sherri Pals; Alyssa Finlay; Phenyo Lekone; Goabaone Rankgoan...; Thato Tlhakanelo; Violet Chihota; Andrew F. Auld
• Keywords: Sputum culture; GeneXpert MTB/RIF; Tuberculosis diagnosis; Nontuberculous Mycobacteria; Culture conversion

Background Patients with non-tuberculous mycobacteria (NTM) or Mycobacterium tuberculosis (MTB) pulmonary disease may have similar clinical presentation. The potential for misdiagnosis and inappropriate treatment exists in settings limited testing capacity Xpert® MTB/RIF (Xpert), phenotypic culture NTM speciation. We describe outcomes among people living HIV (PLHIV) who received anti-tuberculosis were found to MTB positive sputum cultures. Methods PLHIV attending one of the 22 participating clinics, screened ≥1 (TB) symptoms (cough, fever, night sweats, weight loss) asked submit sputa speciation from August 2012 November 2014. national intensified TB case finding algorithms followed: initially symptomatic patients evaluated by samples using a smear (smear-based diagnostic algorithm) and, after GeneXpert instruments installed, Xpert (Xpert-based algorithm). Within study period, used did not include screening, diagnosis, management NTM. Despite negative culture, some patients, including those empirical anti-TB at discretion treating clinicians. Per World Health Organization classification: died, failure loss-to-follow-up classified as unfavorable (unsuccessful) outcome; cured completed favorable (successful) outcome. Empiric was defined initiating without before receiving test result indicating MTB. compare characteristics treatment. Results Among 314 PLHIV, co-infected TB, 146 cases had microbiological evidence; 131/146 cultures reported. One-hundred fifty-two clinically diagnosed treated empirically. empirically 36/152 results NTM, another 43/152 MTB, reported Overall, 174 (131 plus 43) patients. Treatment available 32/36 139/174 MTB; 12.5% 8.7% respectively, p = 0.514, respectively. For 34/36 tested all indicated ‘no MTB’. empiric ultimately outcome 11.8% (4/34), compared (4/32) Fisher’s exact 1.00. Conclusions While higher non statistically significant, impact should be overlooked. Our findings suggest that has rapidly rule-out avoid sub-optimal treatment; further research is needed evaluate such potential.