Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis

Tian, Panwen; Shen, Yongchun; Wang, Ye; Wan, Chun; Feng, Mei; Zhu, Jing; Yang, Ting; Chen, Lei; Wen, Fuqiang

doi:10.1042/bsr20140186

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…5,7 Microbiologic confirmation was low in this cohort, and bronchoscopy with nucleic acid amplification tests of bronchial washings and/or endobronchial ultrasound could be a useful consideration for patients with indeterminate phenotypes. 47 Our study of immigrant status in COTS-1 was inspired by previous reports that highlighted immigrants as a unique subpopulation with a higher risk for TB 48,49 and to explore if this phenomenon was replicated in TBU. Our findings concur with these studies but are limited by the crude ''ever an immigrant'' allocation of immigrant status used.…”

Section: Discussionmentioning

confidence: 99%

Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study

Agrawal

Gunasekeran

Raje³

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The aim of this study was to examine regional variation management practices and outcomes for tubercular uveitis (TBU). METHODS.In this retrospective multinational cohort study, patients from 25 international eye care centers diagnosed with TBU with a minimum follow-up of 1 year were included. The geographic variation in treatment outcomes on survival analysis in patients with TBU were analyzed. Treatment failure is defined as a persistence or recurrence of inflammation within 6 months of completing antitubercular therapy, the inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. RESULTS.Records of 945 patients (1485 eyes) with TBU were analyzed. The mean age was 41.3 6 15.0 years (range, 4-90 years), with more males (52.9%, n ¼ 500/945) and predominant Asian ethnicity (74.4%, n ¼ 690/927). Most patients had no symptoms (92.0%, n ¼ 655/712) or history (76.7%, n ¼ 604/787) suggestive of pulmonary tuberculosis (TB). Some patients had evidence of inactive pulmonary TB on chest X-rays (26.9%, n ¼ 189/702) or chest computed tomography (68.6%, n ¼ 109/159). Patients with western geographic origin (logrank ¼ 6.47, P ¼ 0.010), African or Hispanic ethnicity (log-rank ¼ 19.9, P < 0.001), and positive immigrant status (log-rank ¼ 4.89, P ¼ 0.027) had poorer survival outcomes.CONCLUSIONS. This is a first-ever multinational analysis of TBU that highlights regional differences in treatment outcomes for this elusive form of extrapulmonary TB. Our findings will help in the design of future collaborative studies together with internists to develop best practice guidelines for this early opportunity to address TB infection and strategies to target at-risk groups such as immigrants.

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Section: Discussionmentioning

confidence: 99%

Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study

Agrawal

Gunasekeran

Raje³

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…Nucleic acid amplification tests (NAATs), which directly detect nucleic acids of pathogenic bacteria, are widely used for the detection of pathogenic bacteria, such as TB [42]. NAATs are increasingly valued for their efficiency and accuracy of detection, and they play an increasingly important role in the early diagnosis of infectious diseases [43]. Xpert MTB/RIF is currently the most commonly used NAAT for the diagnosis of TB.…”

Section: Plos Onementioning

confidence: 99%

Diagnostic accuracy of the Xpert MTB/RIF assay for tuberculous pericarditis: A systematic review and meta-analysis

Zhong

Shen

et al. 2021

PLoS ONE

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Objective The purpose of this study was to evaluate the diagnostic efficacy of Xpert MTB/RIF for tuberculous pericarditis (TBP). Methods We searched relevant databases for Xpert MTB/RIF for TBP diagnosis until April 2021 and screened eligible studies for study inclusion. We evaluated the effectiveness of Xpert MTB/RIF when the composite reference standard (CRS) and mycobacterial culture were the gold standards, respectively. We performed meta-analyses using a bivariate random-effects model, and when the heterogeneity was obvious, the source of heterogeneity was further discussed. Results We included seven independent studies comparing Xpert MTB/RIF with the CRS and six studies comparing it with culture. The pooled sensitivity, specificity, and area under the curve of Xpert MTB/RIF were 65% (95% confidence interval, 59–72%), 99% (97–100%), and 0.99 (0.97–0.99) as compared with the CRS, respectively, and 75% (53–88%), 99% (90–100%), and 0.94 (0.92–0.96) as compared with culture, respectively. There was no significant heterogeneity between studies when CRS was the gold standard, whereas heterogeneity was evident when culture was the gold standard. Conclusions The sensitivity of Xpert MTB/RIF for diagnosing TBP was moderate and the specificity was good; thus, Xpert MTB/RIF can be used in the initial diagnosis of TBP.

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“…According to a meta-analysis of nine studies with a total of 1,214 subjects, nucleic acid amplification tests on BALF samples have important diagnostic value for smear-negative PTB, and the pooled sensitivity and specificity were 0.54 [95% confidence interval (CI): 0.48–0.59] and 0.97 (95% CI: 0.95–0.98), respectively ( Tian et al, 2015 ). Based on these findings, the present study selected culture, Xpert MTB/RIF, and SAT-TB for use in the parallel detection of TB to potentially improve TB diagnostic performance.…”

Section: Discussionmentioning

confidence: 99%

Parallel Tests Using Culture, Xpert MTB/RIF, and SAT-TB in Sputum Plus Bronchial Alveolar Lavage Fluid Significantly Increase Diagnostic Performance of Smear-Negative Pulmonary Tuberculosis

Fan

Zhang

et al. 2018

Front. Microbiol.

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At present, tuberculosis remains a serious threat to human health. The diagnosis of pulmonary tuberculosis (PTB) is still difficult, and the prominent challenge for diagnosis is the lack of a highly sensitive and specific method. In order to explore the diagnostic value of parallel tests, this study prospectively enrolled 258 patients with smear-negative PTB from May 2, 2015 to December 31, 2016. The sputum specimens and bronchial alveolar lavage fluid (BALF) samples from all patients were assessed for MTB detection by culture, Xpert MTB/RIF, and simultaneous amplification and testing method for TB (SAT-TB). Overall, the sensitivity of any single test using culture, Xpert MTB/RIF, or SAT-TB was lower than that for parallel tests (p < 0.05), and the sensitivity rates for MTB detection in BALF were significantly higher than those in sputum samples. There were lower agreements in the detection results between sputum samples and BALF for all tests (p < 0.05). The parallel tests models of using culture plus Xpert MTB/RIF plus SAT-TB, culture plus Xpert, or culture plus SAT-TB achieved higher sensitivities compared with all three single test models (p < 0.05). Additionally, joint detection using sputum and BALF samples achieved a high sensitivity (0.8566, 95% CI: 0.8086–0.8941). In conclusion, the parallel tests model using culture, Xpert MTB/RIF, and SAT-TB in sputum plus BALF significantly increases the diagnostic performance of smear-negative PTB; thus, this method should be applied clinically when PTB is suspected but smear results are negative.

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Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis

Cited by 9 publications

References 25 publications

Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study

Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study

Diagnostic accuracy of the Xpert MTB/RIF assay for tuberculous pericarditis: A systematic review and meta-analysis

Parallel Tests Using Culture, Xpert MTB/RIF, and SAT-TB in Sputum Plus Bronchial Alveolar Lavage Fluid Significantly Increase Diagnostic Performance of Smear-Negative Pulmonary Tuberculosis

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