GeneXpert: a game changer in the detection and diagnosis of childhood tuberculosis

A BSTRACT Background: GeneXpert MTB/RIF is a test for early, rapid diagnosis of tubercular meningitis (TBM). Aim: The aim of this article was to study the clinical profile, radiological features, yield of GeneXpert, neurosurgical interventions, and outcome of TBM in children. Settings and Design: This was a retrospective and prospective observational study. Materials and Methods: Diagnosis was based on the uniform research definition criteria and was staged according to the British Medical Research Council. Mantoux test, analysis of cerebrospinal fluid (CSF), CSF GeneXpert, and radiological investigations were performed. Results: Of 36 patients, 50% were aged 1–5 years. Fever (100%), headache (82%), altered sensorium (80%), and vomiting (66%) were common features. Twelve (33%) had contact with active case of tuberculosis; 32 received Bacille Calmette Guarin vaccination. Neurological features included severe deterioration in sensorium (Glasgow Coma Scale < 8) (38%), mild and moderate deficit in sensorium (31%), hemiparesis (41%), and involvement of sixth (25%) and seventh (22%) cranial nerves. Cerebral vision impairment (25%), papilledema (25%), and dystonia (22%) were other findings. CSF GeneXpert was positive in 37% (12/33) patients. Hydrocephalus and basal exudates (75%) were noted on neuro-imaging. Surgical intervention was performed in children with hydrocephalus (13/27). Omayya reservoir was placed in seven children, of which five needed conversion to ventriculoperitoneal (VP) shunt; direct VP shunt was carried out in six (6/13). Good outcome was noted in 78% at discharge. Stage III TBM ( P = 0.0001), cerebral infarcts ( P = 0.0006), and motor deficits ( P = 0.03) were associated with poor outcome. Sequelae included learning difficulties with poor scholastic performance (31.5%). Conclusion: GeneXpert has high diagnostic specificity, but negative results do not rule out TBM. CSF GeneXpert provided quick results. Placement of Ommaya reservoir in TBM stage II and III with hydrocephalus was not successful. Hydrocephalus was managed conservatively with success (53%).

show abstract

“…[ 7 ] It has comparably greater sensitivity,[ 2 8 ] thus, making it a suitable option for early detection of TBM. [ 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical profile, yield of cartridge-based nucleic acid amplification test (GeneXpert), and outcome in children with tubercular meningitis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…6 These results are further reinforced by independent studies. 7 WHO recommends the use of CBNAAT Xpert MTB/RIF as the initial diagnostic test in adults and children with a probability of MDR TB. However, the procedure is not without its problems and pitfalls.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Saha¹,

Saha²

2018

jebmh

View full text Add to dashboard Cite

BACKGROUND Tuberculosis is a chronic multi system granulomatous disease with a predilection for the respiratory system. Traditional diagnostic protocols include history, chest x-ray and sputum collection and staining for acid fast bacilli along with culture in conventional media. These processes are time consuming and labour intensive. WHO recommends the use of Cartridge Based Nucleic Acid Amplification Testing (CBNAAT) using the Gene Xpert MTB/RIF apparatus which is a comparatively rapid PCR based test. MATERIALS AND METHODS In the present study, sputum and tissue samples from 1299 patients were taken and smear preparations were stained for acid fast bacilli. Subsequently, the samples were subjected to CBNAAT testing for both the presence of mycobacterium tuberculosis as well as rifampicin resistance, which is a marker for INH resistance as well. Rifampicin resistant tuberculosis is thus labelled as multi drug resistant tuberculosis (MDR TB). RESULTS In the results of the study, mycobacterium tuberculosis (MTB) was found in 1275 cases, Rifampicin sensitivity was found in 1095 cases, rifampicin resistance in 176 cases and indeterminate results in 4 cases. In 122 cases of the present study, CBNAAT has detected mycobacterium tuberculosis (MTB) where the cases were smear negative. On the other hand, 109 smear positive cases have been declared MTB negative by CBNAAT testing. 26 cases showed error, invalid test and no results. In 4 cases though MTB was detected, rifampicin resistance testing showed indeterminate results. CONCLUSION CBNAAT technology may be used as the standard diagnostic tool for tuberculosis. However for disputed cases, referral systems must be in place for mycobacterial culture and drug testing at reference laboratories.

show abstract

GeneXpert: a game changer in the detection and diagnosis of childhood tuberculosis

Cited by 2 publications

References 23 publications

Clinical profile, yield of cartridge-based nucleic acid amplification test (GeneXpert), and outcome in children with tubercular meningitis

Clinical profile, yield of cartridge-based nucleic acid amplification test (GeneXpert), and outcome in children with tubercular meningitis

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Contact Info

Product

Resources

About