Diagnostic accuracy of the loop-mediated isothermal amplification assay for extrapulmonary tuberculosis: A meta-analysis

Yu, Guocan; Shen, Yanqin; Zhong, Fangming; Ye, Bo; Yang, Jun; Chen, Gang

doi:10.1371/journal.pone.0199290

Cited by 34 publications

(30 citation statements)

References 38 publications

(37 reference statements)

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“…NAATs, such as Xpert MTB/RIF assay and the loop-mediated isothermal amplification assay, are fast and efficient detection methods. Hence, they have been widely used in the early diagnosis of TB [ 29 , 30 ]. Moreover, they have an extremely good diagnostic performance in paucibacillary EPTB [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis

Yu¹,

Zhao²,

Shen³

et al. 2020

PLoS ONE

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Background Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis and its early diagnosis is very difficult leading to present with severe disability or die. The current study aimed to assess the accuracy of metagenomic next generation sequencing (mNGS) for TBM, and to identify a new test for the early diagnosis of TBM. Methods We searched for articles published in Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data up to June 30, 2020 for studies that assessed the efficacy of mNGS for the diagnosis of TBM. Then, the accuracy between mNGS and a composite reference standard (CRS) in these articles was compared using the meta-analysis approach. Results Four independent studies with 342 samples comparing mNGS and a CRS were included in this study. The sensitivity of mNGS for TBM diagnosis ranged from 27% to 84%. The combined sensitivity of mNGS was 61%, and the I2 value was 92%. Moreover, the specificity of mNGS for TBM diagnosis ranged from 96% to 100%. The combined specificity of mNGS was 98%, and the I2 value was 74%. The heterogeneity between studies in terms of sensitivity and specificity was significant. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) of mNGS for TBM was 0.98. Conclusions The sensitivity of mNGS for TBM diagnosis was moderate. Furthermore, the specificity was extremely high, and the AUC of the SROC indicated a very good diagnostic efficacy. mNGS could be used as an early diagnostic method for TBM, however, the results should be treated with caution for the heterogeneity between studies was extremely significant. Systematic review registration INPLASY202070100.

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Section: Discussionmentioning

confidence: 99%

Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis

Yu¹,

Zhao²,

Shen³

et al. 2020

PLoS ONE

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“…Nucleic acid tests such as the loop-mediated isothermal amplification assay, as a fast and efficient detection method, has been widely used in the diagnosis of tuberculosis [49] and demonstrated good diagnostic efficacy in the detection of EPTB [50]. The Xpert MTB/RIF assay, a rapid and automated real-time nucleic acid amplification test is currently one of the most commonly used in the diagnosis of tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Shen¹,

Yu²,

Zhong³

et al. 2019

PLoS ONE

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BackgroundThis study aimed to evaluate the accuracy of the Xpert MTB/RIF assay for the diagnosis of bone and joint tuberculosis. MethodsWe searched databases from their inception to May 7, 2019 for published articles and reviewed them to assess the accuracy of Xpert MTB/RIF with respect to a composite reference standard (CRS) and mycobacterial culture. Meta-analyses were performed using a bivariate random-effects model, and the sources of heterogeneity were assessed via subgroup analysis and meta-regression. ResultsNineteen independent (9 prospective, 5 retrospective, and 5 case-control) studies that compared Xpert MTB/RIF with the CRS and 14 (6 prospective, 7 retrospective, and 1 case-control) studies that compared it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 81% (95% confidence interval [CI], 77-84) and 99% (95% CI, 97-100) compared to the CRS, respectively, and 96% (95% CI, 90-98) and 85% (95% CI, 57-96) compared to culture, respectively. The pooled sensitivity and specificity using pus samples vs. the CRS were 82% (95% CI, 76-86) and 99% (95% CI, 95-100), respectively. The proportions obtained while working with tissue samples vs. the CRS were 84% (95% CI, 76-90) and 98% (95% CI, 94-99), respectively. There was no significant difference in diagnostic accuracy among the types of specimens. ConclusionsXpert MTB/RIF demonstrates good diagnostic accuracy for bone and joint tuberculosis, the results of which are not related to the type of specimen.

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“…Xpert MTB/RIF and Xpert Ultra should not be used as the sole diagnostic test in TBM and every attempt should be made to obtain samples from elsewhere such as sputum, gastric aspirates, lymph node aspirates, biopsies, to support the diagnosis. Recent rapid diagnostic tests, such as TB-LAMP (loop-mediated isothermal amplification), which amplifies MTB DNA and is implementable at peripheral health centre level, and urinary TB FujiLAM, which detects M. tuberculosis lipoarabinomannan antigen, remove the need for advanced laboratory expertise [ 29 , 30 , 31 ]. However, information on their role in TBM diagnosis, diagnostic performance in the paediatric population, and impact on mortality have yet to be clearly elucidated.…”

Section: Pillar 2: Diagnosis and Treatmentmentioning

confidence: 99%

Defeating Paediatric Tuberculous Meningitis: Applying the WHO “Defeating Meningitis by 2030: Global Roadmap”

et al. 2021

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Children affected by tuberculous meningitis (TBM), as well as their families, have needs that lie at the intersections between the tuberculosis and meningitis clinical, research, and policy spheres. There is therefore a substantial risk that these needs are not fully met by either programme. In this narrative review article, we use the World Health Organization (WHO) “Defeating Meningitis by 2030: global roadmap” as a starting point to consider key goals and activities to specifically defeat TBM in children. We apply the five pillars outlined in the roadmap to describe how this approach can be adapted to serve children affected by TBM. The pillars are (i) prevention; (ii) diagnosis and treatment; (iii) surveillance; (iv) support and care for people affected by meningitis; and (v) advocacy and engagement. We conclude by calling for greater integration between meningitis and TB programmes at WHO and at national levels.

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Diagnostic accuracy of the loop-mediated isothermal amplification assay for extrapulmonary tuberculosis: A meta-analysis

Cited by 34 publications

References 38 publications

Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis

Metagenomic next generation sequencing for the diagnosis of tuberculosis meningitis: A systematic review and meta-analysis

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Defeating Paediatric Tuberculous Meningitis: Applying the WHO “Defeating Meningitis by 2030: Global Roadmap”

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