Clinical spectrum of admitted patients undergoing Xpert MTB/RIF® testing for tuberculosis evaluation at a tertiary care hospital

Abstract

Background: The introduction of Xpert MTB/RIF® has revolutionised the diagnosis of tuberculosis (TB) by reducing time to the identification and detection of drug resistance. Methods: We prospectively studied clinical profile of admitted patients who underwent Xpert MTB/RIF® for the diagnosis of TB in the Department of Medicine and Allied Specialties at our tertiary care teaching hospital in Ludhiana. Results: During the period from January to December 2018, 140 patients (mean age 55.7 ± 16 years; male: female = 1.5:1) were included. Type 2 diabetes mellitus was the most common comorbid disease (n = 37; 26.4%). The most common presenting complaints were fever, breathlessness and cough with expectoration. Overall, 61 admitted patients were discharged with a diagnosis of TB; 26/61 (42.6%) tested Xpert MTB/RIF® positive (bacteriologically confirmed); the remaining 35 (57.4%) were clinically diagnosed along with the ancillary supportive investigations. The remaining 79 patients had a non-TB diagnosis. In extrapulmonary TB, Xpert MTB/RIF® had low detection and positivity rate as compared to other ancillary investigations for TB. Conclusions: Xpert MTB/RIF® was useful in the diagnosis in 42.6% of cases. When Xpert MTB/RIF® was negative, TB was diagnosed empirically on the basis of clinical, radiological and ancillary laboratory investigations. Xpert MTB/RIF® positivity with the clinical background suggesting that TB makes the diagnosis rapidly and with a high degree of confidence.