Diagnostic performances of the Xpert MTB/RIF in Brazil

Silva, Denise Rossato; Sotgiu, Giovanni; D’Ambrosio, Lia; Pereira, Gabriel Ribas; Barbosa, Márcia Silva; Dias, Natan José Dutra; Saderi, Laura; Centis, Rosella; Migliori, Giovanni Battista

doi:10.1016/j.rmed.2017.11.012

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…There is still a lack of information about Xpert performance under programmatic conditions in Brazil despite its regular use in many high-burden cities since 2014 [5]. Recent studies in Brazil showed that the use of the Xpert MTB/RIF increased detection of TB cases among paucibacillary patients [14], adolescents [15] and the HIV-positive population [16].…”

Section: Discussionmentioning

confidence: 99%

Xpert MTB/RIF performance to diagnose tuberculosis and rifampicin resistance in a reference centre in southern Brazil

et al. 2019

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Effective treatment of tuberculosis (TB) remains a serious public health problem in many countries, including Brazil, especially when considering drug-resistant disease. Xpert MTB/RIF has been implemented in many countries to reduce the time to TB diagnosis and to rapidly detect rifampicin resistance. The study aimed to describe and evaluate Xpert MTB/RIF performance in diagnosing pulmonary TB and rifampicin resistance in a tertiary healthcare facility in Brazil.A cross-sectional study was performed, which included all isolates of confirmed pulmonary TB patients from 2015 to 2018. Both Xpert MTB/RIF and GenoType MTBDRplus assays were performed to detect rifampicin and isoniazid resistance. In addition, isolates with detected resistance to rifampicin and/or isoniazid were analysed by phenotypic testing using MGIT-960 SIRE kit and whole-genome sequencing (WGS) using Illumina MiSeq Sequencing System.2148 respiratory specimens tested with Xpert MTB/RIF were included: n=1556 sputum, n=348 bronchoalveolar lavage and n=244 gastric washing. The overall Xpert MTB/RIF sensitivity in sputum was 94% and the overall specificity was 98%. The negative predictive value in sputum of all the patients was 99% with a positive predictive value of 89%. The concordance between Xpert MTB/RIF and phenotypic susceptibility test was 94.1%, while its concordance with WGS was 78.9%.Xpert MTB/RIF is a rapid and accurate diagnostic strategy for pulmonary TB, which can contribute to improvement in TB control. However, detection of rifampicin resistance might be associated with false-positive results.

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Section: Discussionmentioning

confidence: 99%

Xpert MTB/RIF performance to diagnose tuberculosis and rifampicin resistance in a reference centre in southern Brazil

et al. 2019

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“…Models predict that elimination of TB can be reached within the next few decades and can discern what the relevant contribution of a new vaccine, new (shorter and better tolerated) regimens to manage TB and LTBI and a new point of care diagnostic test would be [32,33]. Diagnosis and treatment of LTBI outperforms other interventions in these scenarios.…”

Section: The End Tb Strategymentioning

confidence: 99%

“…Recent evidence suggests that correct treatment is extremely effective in rendering the patient rapidly non-infectious. Today, the availability of rapid diagnostic methods allows us to identify, within a few hours, whether the strain is susceptible or resistant to drugs and, therefore, enables appropriate treatment accordingly [32,33,[35][36][37]. Unfortunately, the practice of treating patients with the standard regimen for new cases ("blindly" as far as drug resistance is concerned) and considering drug susceptibility testing only when treatment failure occurs is still common in many settings [93].…”

Section: The End Tb Strategymentioning

confidence: 99%

“…Furthermore, a TB research network was created (the ALAT/ERS LATSINTB project) to tackle the evidence gap, based on the positive results achieved by previous informal collaboration between ERS and Latin American researchers [28,32,33,47,49,63,71,72,84,85,[98][99][100]. These, as well as similar initiatives, are necessary and properly coordinated with well-designed national research plans.…”

Section: A Regional Approach: the Experience Of Latin Americamentioning

confidence: 99%

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Tuberculosis elimination: where are we now?

et al. 2018

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Tuberculosis (TB) still represents a major public health issue in spite of the significant impact of the efforts made by the World Health Organization (WHO) and partners to improve its control. In 2014 WHO launched a new global strategy (End TB) with a vision of a world free of TB, and a 2035 goal of TB elimination (defined as less than one incident case per million). The aim of this article is to summarise the theoretical bases of the End TB Strategy and to analyse progresses and persistent obstacles on the way to TB elimination.The evolution of the WHO recommended strategies of TB control (Directly Observed Therapy, Short Course (DOTS), Stop TB and End TB) are described and the concept of TB elimination is discussed. Furthermore, the eight core activities recently proposed by WHO as the milestones to achieve TB elimination are discussed in detail. Finally, the recently published experiences of Cyprus and Oman on their way towards TB elimination are described, together with the regional experience of Latin America.New prevention, diagnostic and treatment tools are also necessary to increase the speed of the present TB incidence decline.

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“…Both articles emphasize that is essential to determine the effect of the Xpert MTB/RIF assay on the diagnosis of tuberculosis under programmatic conditions in Brazil. (11) Improving the coverage and quality of diagnosis for individuals infected with drug-resistant tuberculosis is also relevant. In a cohort study conducted at a referral center for tuberculosis in the state of São Paulo, Brazil, between 2006 and 2010, (7) the authors found that early detection of infection with a drug-resistant strain of M. tuberculosis was associated with higher cure rates in patients without comorbidities and in patients with a higher body weight at the beginning of treatment (in comparison with the cure rates observed for those without comorbidities and for those with a lower body weight at the beginning of treatment).…”

mentioning

confidence: 99%