Comparison Acid Fast Bacilli Smear Microscopy Examination with Xpert MTB/RIF in Diabetes Mellitus Patients Who Suspected Pulmonary Tuberculosis

· Biomolecular, Lung Infection

Sukara Safril Kusuma Jaya¹, Erlina Burhan¹, Rochsismandoko², Cahyarini³
¹Departemen Pulmonologi dan Ilmu Kedokteran Respirasi, Fakultas Kedokteran Universitas Indonesia, RS Persahabatan, Jakarta
²SMF Penyakit Dalam, Divisi Metabolik dan Endokrin, RS Persahabatan, Jakarta
³SMF Mikrobiologi, RS Persahabatan, Jakarta

Background: The relationship between tuberculosis (TB) and Diabetes Mellitus (DM) has long been known. People with DM have 2-3 times the risk of developing TB. The prevalence of TB-DM based in Endocrine clinic in Persahabatan Hospital in DM type 2 patients in 2013 was 28.2%. Diabetes mellitus poorly controlled or uncontrolled associated with an increased risk of TB. The main objective of this study was to determine the sensitivity and specificity of Acid Fast Bacilli (AFB) smear and Xpert MTB/RIF for diagnosis of TB in DM.
Methods: This study was a cross-sectional descriptive analytic study in patients with DM group were still underwent treatment at Persahabatan Hospital from May 2014. The study was conducted in Pulmonary clinic and Internal Medicine clinic. Patients with DM who have TB complaints that have not been taken either TB drug or with a history of treatment and supported from chest X-ray shows the suspicion of TB will require the microbiological diagnosis of AFB smear and Xpert MTB/RIF.
Result: Seventy subject was screening and only 55 subject met the inclusion criteria. There were 32 males (58.2%) and 23 females (41.8%). Age between 25-72 years old. Body mass index were less 11(20%), normal 31(56.4%) and over 13(23.6%). The blood sugar between 110-481 g/dl. The length of suffer DM <5 years were 40(72.7%), 5-10 years were 7(12.7%), 10-15 years were 6(10.9%) and >15 years were 2(3.6%). The controlled HbA1c 11(20%) and uncontrolled 44(80%). By history of TB has never suffered 41(74.5%), treatment cured 9(16.4%) and failure or withdrawal 5(9.1%). Smear of AFB(+)ve 29 (52.7%) and Xpert MTB/RIF(+) 36(65.5%). Uncontrolled HbA1c levels pulmonary TB with AFB smear/Xpert (+)ve 30(54.5%). Sensitivity and specificity by using both 77.8% and 94.7%.
Conclusion: The Xpert MTB/RIF has a higher value of positivity that detect M.Tb than AFB smear.There is no difference in the sensitivity and specificity of AFB smear and Xpert MTB/RIF for TB diagnosis in patients with DM. (J Respir Indo. 2015; 35: 144-57)
Keywords: Diabetes mellitus, tuberculosis, AFB smear, Xpert MTB/RIF

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