Missed Opportunities for the Diagnosis of Pulmonary Tuberculosis in Ashanti and Western Regions of Ghana; Polymerase Chain Reaction, A Better Tool

Abstract

The diagnosis of Pulmonary Tuberculosis (PTB) has mainly relied on sputum microscopy and culture. The use of molecular techniques such as the Polymerase Chain Reaction (PCR) and its overwhelming advantages compared with conventional diagnostic methodologies cannot be overemphasized. The main aim of this work was to compare the diagnostic sensitivities of microscopy, culture and PCR. Suspected PTB sputum samples were prospectively collected from six hospitals in the Ashanti and Western regions of Ghana. Microscopy was carried out on all samples at the field sites. Apart from culture and PCR, repeat sputum microscopy was carried out in the laboratories of the Kumasi Centre for Collaborative Research (KCCR). Out of the total 425 cases recruited for the study, 123 (29.0%) were smear positive on site in contrast to 275 (64.7%) positivity rate at KCCR. Regarding culture, 254 (59.9%) samples were culture positive whilst PCR technique using INS 1&2 and PR 8&9 primers were positive in 59.9 % and 56% of cases respectively. The proportion of missed positive cases of microscopy were 131 (51%) compared with culture and 1.1% missed cases when compared with PCR. The sensitivity and specificity of microscopy were 123/254 (48.4%) and 154/302 (50.99%). The study confirms the superiority of PCR in the diagnosis of PTB and indicates that a substantial proportion of PTB cases are missed when microscopy alone is used. In areas where the incidence of PTB is high and at referral hospitals, PCR can be done to augment the diagnosis of TB.

Keywords: Pulmonary Tuberculosis, Sputum Microscopy, Culture, Polymerase Chain Reaction