Accuracy of a rapid molecular test for tuberculosis in sputum samples, bronchoalveolar lavage fluid, and tracheal aspirate obtained from patients with suspected pulmonary tuberculosis at a tertiary referral hospital

Silva, Tatiane Maria da; Soares, Valéria Martins; Ramos, Mariana Gontijo; Santos, Adriana dos

doi:10.1590/1806-3713/e20170451

Cited by 15 publications

(16 citation statements)

References 11 publications

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“…Some studies have concluded that Xpert detects MTB for up to five years after treatment [48,49]. Therefore, in these cases, the diagnosis of active TB should be performed by smear and culture tests, whereas the molecular test is recommended for early diagnosis and is not indicated for monitoring therapeutic response [50]. In our study, there were five patients who did not have active TB but had previously undergone treatment, and one patient was under treatment at the time of the molecular test and were considered "not TB".…”

Section: Plos Onementioning

confidence: 99%

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

Tomaz¹,

Raboni²,

Kussen³

et al. 2021

PLoS ONE

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Xpert® MTB/RIF has been widely used for tuberculosis (TB) diagnosis in Brazil, since 2014. This prospective observational study aimed to evaluate the performance of Xpert in different contexts during a two-year period: (i) laboratory and clinical/epidemiological diagnosis; (ii) HIV-positive and -negative populations; (iii) type of specimens: pulmonary and extrapulmonary. Overall, 924 specimens from 743 patients were evaluated. The performance of the assays was evaluated considering culture (Lowenstein Jensen or LJ medium) results and composite reference standard (CRS) classification as gold standard. According to CRS evaluation, 219 cases (29.5%) were classified as positive cases, 157 (21.1%) as ‘possible TB’, and 367 (49.3%) as ‘not TB’. Based on culture, Xpert and AFB smear achieved a sensitivity of 96% and 62%, respectively, while based on CRS, the sensitivities of Xpert, AFB smear, and culture were 40.7%, 20%, and 25%, respectively. The pooled sensitivity and specificity of Xpert were 96% and 94%, respectively. Metric evaluations were similar between pulmonary and extrapulmonary samples against culture, whereas compared to CRS, the sensitivities were 44.6% and 29.3% for the pulmonary and extrapulmonary cases, respectively. The Xpert detected 42/69 (60.9%) patients with confirmed TB and negative culture on LJ medium, and 52/69 (75.4%) patients with negative AFB smear results. There was no significant difference in the diagnostic accuracy based on the types of specimens and population (positive- and negative-HIV). Molecular testing detected 13 cases of TB in culture-negative patients with severe immunosuppression. Resistance to rifampicin was detected in seven samples. Herein, Xpert showed improved detection of pulmonary and extrapulmonary TB cases, both among HIV-positive and -negative patients, even in cases with advanced immunosuppression, thereby performing better than multiple other diagnostic parameters.

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Section: Plos Onementioning

confidence: 99%

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

Tomaz¹,

Raboni²,

Kussen³

et al. 2021

PLoS ONE

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“…Bronchoscopy can be valuable for these patients as it can obtain suitable specimens from the lower respiratory tract while inspecting all the available airways (Mondoni et al, 2017). Literature regarding the diagnostic accuracy of the Xpert assay on bronchoalveolar lavage fluid (BALF) is limited, and most studies have used small sample sizes (Barnard et al, 2015;Fakey Khan et al, 2019;Kilaru et al, 2019;Li et al, 2020;Lu et al, 2018;Pan et al, 2018;Silva et al, 2019;Theron et al, 2013;Theron et al, 2014). Due to this limited research, no formal recommendation for using the Xpert MTB/RIF assay on BAFL exists.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the Xpert Mycobacterium tuberculosis/rifampicin assay for diagnosing sputum-smear negative or sputum-scarce pulmonary tuberculosis in bronchoalveolar lavage fluid

Yang

Shen

Wang

et al. 2021

International Journal of Infectious Diseases

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To evaluate he diagnostic performance of the Xpert Mycobacterium tuberculosis/Rifampin (MTB/RIF) assay in bronchoalveolar lavage fluid (BALF). Methods: We retrospectively reviewed the clinical data from 671 sputum-smear negative or sputumscarce adult patients with suspected pulmonary tuberculosis (PTB) who had an Xpert MTB/RIF assay performed on BALF. The diagnostic performance of the Xpert MTB/RIF assay, smear microscopy (SM) and MTB culture was evaluated using MTB culture or final clinical diagnosis as the reference standard. Results: Compared with MTB culture, the sensitivity and specificity were 87.8% and 72.7% for the Xpert MTB/RIF assay and 11.0% and 99.2% for SM, respectively. Compared with final diagnosis, diagnostic performance was 58.9% and 83.9% for the Xpert MTB/RIF assay, 5.0% and 98.3% for SM, and 43.3% and 100% for culture, for sensitivity and specificity respectively. The Xpert MTB/RIF assay had low specificity and high sensitivity. When very low results were re-evaluated and considered MTB-negative, the specificity increased significantly. The sensitivity remained higher than SM and was similar to that of culture. Conclusions: The Xpert MTB/RIF assay adds microbiologic evidence to clinical decisions; however, close attention should be paid to very low semi-quantitative positive results.

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“…We identified 50 articles: 17 [7,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] in the adult BAL group, 14 [35,[40][41][42][43][44][45][46][47][48][49][50][51][52] in the adult ES group, 7 [35,45,50,[53][54][55][56] in the adult IS group, 2 [57,58] in the pediatric ES group, 6 [57,[59][60][61][62][63] in the pediatric GA group, and 9 [59,[64][65][66][67]…”

Section: Studies' Characteristicsmentioning

confidence: 99%

Which sample type is better for Xpert MTB/RIF to diagnose adult and pediatric pulmonary tuberculosis?

et al. 2020

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Objective: This review aimed to identify proper respiratory-related sample types for adult and pediatric pulmonary tuberculosis (PTB), respectively, by comparing performance of Xpert MTB/RIF when using bronchoalveolar lavage (BAL), induced sputum (IS), expectorated sputum (ES), nasopharyngeal aspirates (NPA) and gastric aspiration (GA) as sample. Methods: Articles were searched in Web of Science, PubMed, and Ovid from inception up to June 29, 2020. Pooled sensitivity and specificity were calculated, each with a 95% confidence interval (CI). Quality assessment and heterogeneity evaluation across included studies were performed. Results: Fifteen articles were included. The respective sensitivity and specificity were 87% (95% CI: 0.84–0.89), 91% (95% CI: 0.90–0.92) and 95% (95% CI: 0.93–0.97) in the adult BAL group, 90% (95% CI: 0.88–0.91), 98% (95% CI: 0.97–0.98) and 97% (95% CI: 0.95–0.99) in the adult ES group, 86% (95% CI: 0.84–0.89) and 97% (95% CI: 0.96–0.98) in the adult IS group, 14% (95% CI: 0.10–0.19) and 99% (95% CI: 0.97–1.00) in the pediatric ES group, 80% (95% CI: 0.72–0.87) and 94% (95% CI: 0.92–0.95) in the pediatric GA group, 67% (95% CI: 0.62–0.72) and 99% (95% CI: 0.98–0.99) in the pediatric IS group, and 54% (95% CI: 0.43–0.64) and 99% (95% CI: 0.97–0.99) in the pediatric NPA group. The heterogeneity across included studies was deemed acceptable. Conclusion: Considering diagnostic accuracy, cost and sampling process, ES was a proper choice for adult PTB. GA might be more suitable than others for pediatric PTB. The actual choice of sample types should consider the needs of specific situations.

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Accuracy of a rapid molecular test for tuberculosis in sputum samples, bronchoalveolar lavage fluid, and tracheal aspirate obtained from patients with suspected pulmonary tuberculosis at a tertiary referral hospital

Cited by 15 publications

References 11 publications

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

Efficacy of the Xpert Mycobacterium tuberculosis/rifampicin assay for diagnosing sputum-smear negative or sputum-scarce pulmonary tuberculosis in bronchoalveolar lavage fluid

Which sample type is better for Xpert MTB/RIF to diagnose adult and pediatric pulmonary tuberculosis?

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