M.R.A. van Cleeff

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L E A Kivihya-Ndugga

Kenya Medical Research Institute

Lucy Nganga

Centers for Disease Control and Prevention

Paul R. Klatser

Landscape Research Group

J A Odhiambo

Centers for Disease Control and Prevention

W Githui

Kenya Medical Research Institute

Agnes Dessing

Stichting Apotheek der Haarlemse Ziekenhuizen

PCFM Gondrie

P.R. Klatser

Joseph Odhiambo

Kenya Medical Research Institute

A.H.J. Kolk

Cooperative Institutions

Kenya Medical Research Institute

University of Amsterdam

Centers for Disease Control and Prevention

Academic Medical Center

Royal Tropical Institute

World Health Organization

Ministry of Health

London School of Hygiene & Tropical Medicine

Vrije Universiteit Amsterdam

Amsterdam Institute for Global Health and Development

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A comprehensive comparison of Ziehl-Neelsen and fluorescence microscopy for the diagnosis of tuberculosis in a resource-poor urban setting.

PubMed (2003)

L E A Kivihya-Ndugga M.R.A. van Cleeff W Githui Lucy Nganga D. Kibuga

Nairobi City Council Chest Clinic, Kenya.To establish the efficiency, costs and cost-effectiveness of six diagnostic strategies using Ziehl-Neelsen (ZN) and fluorescence microscopy (FM).A cross-sectional study of 1398 TB suspects attending a specialised chest clinic in Nairobi subjected to three sputum examinations by ZN and FM. Lowenstein-Jensen culture was used as the gold standard. Cost analysis included health service and patient costs.Of 1398 suspects enrolled, 993 (71%) had a complete diagnostic work-up involving three sputum specimens for ZN and FM, culture and chest X-ray (CXR). Irrespective of whether ZN or FM was used on one, two or three smears, the overall diagnostic process detected 92% culture-positive cases. Different strategies affected the ratio of smear-positive to smear-negative TB; however, FM was more sensitive than ZN (P < 0.001). FM performance was not affected by the patient's HIV status. The cost per correctly diagnosed smear-positive case, including savings, was 40.30 US dollars for FM on two specimens compared to 57.70 US dollars for ZN on three specimens.The FM method used on one or two specimens is more cost-effective and shortens the diagnostic process. Consequently, more patients can be put on a regimen for smear-positive TB, contributing to improved treatment and reducing transmission.

Ziehl–Neelsen stain

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A comprehensive study of the efficiency of the routine pulmonary tuberculosis diagnostic process in Nairobi.

PubMed (2003)

M.R.A. van Cleeff L E A Kivihya-Ndugga W Githui Lucy Nganga J A Odhiambo

Tuberculosis (TB) suspects from Rhodes Chest Clinic, Nairobi, Kenya, were subjected to three sputum smear microscopy (Ziehl-Neelsen) examinations and a chest X-ray (CXR). Results were compared with Löwenstein-Jensen culture as the gold standard to establish the efficiency of the routine diagnostic process. All laboratory tests and the CXR were available for 993 (71%) of the 1,398 enrolled suspects. Of these, 554 (56%) were culture-positive. The routine diagnostic process was very sensitive, able to detect 92% of culture-positive cases but missing 8%. The specificity was low (66%), and 23% of the patients started on treatment were culture-negative, mainly due to the low specificity of the CXR. It may be possible to increase the efficiency of the diagnostic process by specifying better criteria for CXR examination, improving the quality of CXR reading and counselling patients to return when complaints persist.

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Tuberculosis in The Netherlands before, during, and after World War II

Progress in respiratory research/Progress in research in emphysema and chronic bronchitis/Progress in respiration research (2018)

M.R.A. van Cleeff Ernest Hueting Agnes Dessing

For The Netherlands, World War II started on May 10, 1940 and ended on May 6, 1945. Mortality from tuberculosis (TB) had shown a gradual pre-war decline of around 7% annually, reaching a nadir of 41/100,000 population in 1939, then worsened throughout the war. Chief factors were the deteriorating food situation, overcrowding, and psychosocial stress. While the morbidity also rose, the risk of infection kept declining. Treatment included eliminating harmful external immunologic factors, hygienic-dietary treatment, surgery, and personal protection. If possible, patients were admitted to sanatoria or hospitals. Because the Nazi occupiers were afraid of TB, these services were left relatively unaffected; some new controls were even introduced, including pasteurization of milk. Nevertheless, the large increase in patients overwhelmed the system and increasing attention was directed towards home care. Later, particularly during the Dutch famine of 1944-1945, known as the Hongerwinter ("Winter of Hunger"), hunger, exhaustion, poor hygiene, and congested living circumstances in shelters took their toll. At the end of 1944, anti-TB clinics stopped operating, and the crumbling general health care system promoted an increase in morbidity and mortality of TB. In 1945, TB mortality had risen to 85.9/100,000, twice as high as in 1939.

Overcrowding

Famine

10.1159/000481481

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Ontwikkeling van op antigenen gebaseerde diagnostische testen voor vroegtijdige immunodiagnose van tuberculose

M.R.A. van Cleeff P.R. Klatser A.H.J. Kolk

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Diagnosis of tuberculosis in high endemic areas : the performance of sputum microscopy, chest X-ray and polymerase chain reaction

L E A Kivihya-Ndugga M.R.A. van Cleeff

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Development of antigen-based diagnostic tests for early immunodiagnosis of tuberculosis

M.R.A. van Cleeff Paul R. Klatser A H Kolk

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Tuberculosis in Elderly

Jaypee Brothers Medical Publishers (P) Ltd. eBooks (2009)

M.R.A. van Cleeff PCFM Gondrie J Veen

10.5005/jp/books/10992_44

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The Proportion of Tuberculosis Cases in Tanzania Attributable to Human Immunodeficiency Virus

International Journal of Epidemiology (1995)

M.R.A. van Cleeff H. J. Chum

Background. Routine data obtained from the National Tuberculosis and Leprosy Programme (NTLP) of Tanzania have shown a constant increase in the notified number of tuberculosis (TB) cases since 1982. Possible causes include an improved reporting system, improvement in health services after the introduction of short course chemotherapy (SCC), and human immunodeficiency virus (HIV) infection. This paper examines to what extent the increased TB case detection rate can be attributed to HIV infection, by calculating the population attributable risk for various years. Method. The prevalence to HIV infection was obtained from data of the National AIDS Control Programme and the relative risk of HIV for developing TB from a case-control study and the literature. Results. Between 1985 and 1989 the increase was the highest among women aged 15–24 years and men aged 25–34 years; age groups in which HIV prevalence is highest. In the case-control study HIV prevalence among blood donors was 9.4% and among smear-positive pulmonary TB patients 51.6%, giving an odds ratio (OR) of 8.1 (95% confidence interval (CI): 4.4–16.3). For all TB cases the OR was 11.8. In a population with an HIV prevalence of 10%, about 40% of the smear-positive TB patients are attributable to HIV. The excess of TB cases in the entire country between 1982 and 1989 can be attributable to HIV infection. This has implications for TB control and socioeconomic consequences in the country.

Attributable risk

10.1093/ije/24.3.637

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Sex-specific performance of routine TB diagnostic tests.

PubMed (2005)

L E A Kivihya-Ndugga M.R.A. van Cleeff Lucy Nganga Hellen Meme Joseph Odhiambo

City Council Chest Clinic, Nairobi, Kenya.To determine to what extent the performance of smear microscopy is responsible for sex differences in notification rates.Three sputum samples from TB suspects were subjected to smear microscopy with Ziehl-Neelsen (ZN) and auramine (FM) staining. Lowenstein-Jensen culture was used as the gold standard.Of 998 suspects, 600 (60%) were men and 398 (40%) women. The odds of detecting culture-positive patients with ZN was lower for women (OR 0.67). By examining the first spot specimen, ZN detected 35% of culture-positive males and 26% of culture-positive females. These proportions increased to respectively 63% and 53% when examining three specimens, and to 79% and 74% when using FM. The sex difference reduced and became non-significant (P = 0.19) when adjusted for HIV; however, the numbers involved for HIV stratification were low.The performance of a diagnostic tool contributes to sex differences in notification rates and influences male/female ratios. Women were less likely to be diagnosed (P = 0.08), and when ZN was used they were less likely to be labelled as smear-positive TB (P < 0.01). The application of more sensitive diagnostic tools such as FM is to the advantage of women.

Ziehl–Neelsen stain

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Sputum culture

Female sex

Odds

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Citations (26)