Abstract
Diagnostic Evaluation of Pulmonary Tuberculosis in Qatar: A Retrospective Analysis of Clinical, Histopathological, and Microbiological Findings
Fatemeh Abdulrasool Vatanparast¹, Nedia Neffati¹, Mushtaq Ahmad2, Aasir Abdel Satar Suliman3, Bisher Sawaf4, Sara Hassan4, Sara Faisal Mohamed5, Eihab Subahi6, Elias Battikh4, Hisham Elhiday4, Fahmi Yousef Khan¹
Keywords: Tuberculosis, diagnostic accuracy, microbiology, histopathology, Qatar, ROC curve
DOI: 10.63475/yjm.v5i1.0391
DOI URL: https://doi.org/10.63475/yjm.v5i1.0391
Publish Date: 30-04-2026
Download PDFPages: 191 - 200
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Author Affiliation:
1 Senior Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
2 Senior Consultant, Pulmonology Department, Hamad General Hospital, Doha, Qatar
3 Specialist, Pulmonology Department, Hamad General Hospital, Doha, Qatar
4 Resident, Department of Medicine, Hamad General Hospital, Doha, Qatar
5 Specialist, Infectious Diseases Department, Hamad General Hospital, Doha, Qatar
6 Specialist, Department of Medicine, Hamad General Hospital, Doha, Qatar
Abstract
Background: Tuberculosis (TB) poses unique diagnostic challenges in Qatar due to its large expatriate population originating from endemic regions. This study evaluated the comparative diagnostic performance of clinical, histopathological, and microbiological methods in a highly selected cohort of suspected pulmonary TB patients who underwent invasive diagnostic procedures.
Methods: A retrospective cross-sectional study was conducted at Hamad General Hospital, Doha, Qatar, reviewing records from January 2010 to December 2019. Out of 3240 screened admissions, 58 patients who underwent comprehensive diagnostic evaluation—including QuantiFERON-TB Gold QuantiFERON®-TB (QFT), tuberculin skin test Purified Protein Derivative (PPD), acid-fast bacilli (AFB) smear, TB culture, and tissue biopsy—were included. Diagnostic accuracy was assessed using sensitivity, specificity, predictive values, likelihood ratios (LRs), and area under the receiver operating characteristic curve (AUC), utilizing histopathological and microbiological findings as reference standards.
Results: The cohort was predominantly female (77.6%) and non-Qatari (96.6%), with a mean age of 33.6 years. Classic constitutional symptoms were surprisingly infrequent (cough 29.3%, fever 17.2%, weight loss 17.2%). Radiological abnormalities were present in 75.9% of chest X-rays and 65.5% of computed tomography scans. Microbiological culture demonstrated the highest positive predictive value (90.3%) and a moderate rule-in value (LR+ ≈ 2.4), though its overall discriminative ability was modest (AUC = 0.64). Biopsy culture showed strong rule-in potential (LR+ > 5). Conversely, immunological assays (QFT, PPD) and AFB smear exhibited very low sensitivity (ranging from 4.4% to 14.3%) and LRs close to 1, indicating minimal diagnostic utility for confirming active disease in this complex cohort.
Conclusions: In suspected pulmonary TB cases requiring advanced diagnostic workup, immunological tests and sputum smear microscopy lack the sensitivity to rule in active disease reliably. While tissue and sputum cultures provided the most meaningful diagnostic confirmation, their overall accuracy was moderate. These findings highlight the limitations of conventional triage tests in highly selected populations and underscore the critical need to integrate rapid molecular diagnostics, such as GeneXpert, into clinical algorithms to bridge the diagnostic gap.