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Epidemiology

C-Reactive Protein Testing for Active Tuberculosis among Inpatients without HIV in Uganda: a Diagnostic Accuracy Study

Amanda J. Meyer, Emmanuel Ochom, Patricia Turimumahoro, Patrick Byanyima, Ingvar Sanyu, Rejani Lalitha, Sylvia Kaswabuli, Alfred Andama, Nicholas D. Walter, Achilles Katamba, Adithya Cattamanchi, William Worodria, Laurence Huang, Christina Yoon, J. Lucian Davis
Daniel J. Diekema, Editor
Amanda J. Meyer
aDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
bUganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
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Emmanuel Ochom
bUganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
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Patricia Turimumahoro
bUganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
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Patrick Byanyima
cInfectious Diseases Research Collaboration, Kampala, Uganda
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Ingvar Sanyu
cInfectious Diseases Research Collaboration, Kampala, Uganda
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Rejani Lalitha
dDepartment of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
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Sylvia Kaswabuli
cInfectious Diseases Research Collaboration, Kampala, Uganda
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Alfred Andama
cInfectious Diseases Research Collaboration, Kampala, Uganda
dDepartment of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
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Nicholas D. Walter
eDivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Achilles Katamba
bUganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
fClinical Epidemiology Unit, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Adithya Cattamanchi
bUganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
gDivision of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
hCurry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
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William Worodria
dDepartment of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
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Laurence Huang
gDivision of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
iDivision of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, USA
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Christina Yoon
gDivision of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
hCurry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
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J. Lucian Davis
aDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
bUganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
jCenter for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
kPulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
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Daniel J. Diekema
University of Iowa College of Medicine
Roles: Editor
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DOI: 10.1128/JCM.02162-20
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ABSTRACT

The objective of this prospective cross-sectional study, conducted at a national referral hospital in Kampala, Uganda, was to determine diagnostic performance of serum C-reactive protein (CRP) as a triage test for tuberculosis (TB) among HIV-seronegative inpatients. We calculated the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values to determine the diagnostic performance of a CRP enzyme-linked immunosorbent assay (ELISA) (Eurolyser) in comparison to that of a reference standard of Mycobacterium tuberculosis culture on two sputum samples. We constructed receiver operating curves and reported performance in reference to the manufacturer’s cutoff and also to a threshold chosen to achieve sensitivity of >90%, in accordance with the WHO’s target-product profile for a triage test. Among 119 HIV-seronegative inpatients, 46 (39%) had culture-positive pulmonary TB. In reference to M. tuberculosis culture, CRP had a sensitivity of 78% (95% confidence interval [CI], 64 to 89%) and a specificity of 52% (95% CI, 40 to 64%) at the manufacturer’s threshold of 10 mg/liter. At a threshold of 1.5 mg/liter, the sensitivity was 91% (95% CI, 79 to 98%) but the specificity was only 21% (95% CI, 12 to 32%). Performance did not differ when stratified by illness severity at either threshold. In conclusion, among HIV-seronegative inpatients, CRP testing performed substantially below targets for a TB triage test. Additional studies among HIV-seronegative individuals in clinics and community settings are needed to assess the utility of CRP for TB screening.

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C-Reactive Protein Testing for Active Tuberculosis among Inpatients without HIV in Uganda: a Diagnostic Accuracy Study
Amanda J. Meyer, Emmanuel Ochom, Patricia Turimumahoro, Patrick Byanyima, Ingvar Sanyu, Rejani Lalitha, Sylvia Kaswabuli, Alfred Andama, Nicholas D. Walter, Achilles Katamba, Adithya Cattamanchi, William Worodria, Laurence Huang, Christina Yoon, J. Lucian Davis
Journal of Clinical Microbiology Dec 2020, 59 (1) e02162-20; DOI: 10.1128/JCM.02162-20

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C-Reactive Protein Testing for Active Tuberculosis among Inpatients without HIV in Uganda: a Diagnostic Accuracy Study
Amanda J. Meyer, Emmanuel Ochom, Patricia Turimumahoro, Patrick Byanyima, Ingvar Sanyu, Rejani Lalitha, Sylvia Kaswabuli, Alfred Andama, Nicholas D. Walter, Achilles Katamba, Adithya Cattamanchi, William Worodria, Laurence Huang, Christina Yoon, J. Lucian Davis
Journal of Clinical Microbiology Dec 2020, 59 (1) e02162-20; DOI: 10.1128/JCM.02162-20
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KEYWORDS

CRP
Africa
diagnosis

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