GeneXpert® MTB/RIF for rapid detection of <i>Mycobacterium tuberculosis</i> in pulmonary and extra-pulmonary samples [Correspondence]

Hanif, Sajid; Eldeen, Hana S.; Ahmad, Suhail; Mokaddas, Eiman

doi:10.5588/ijtld.11.0394

Cited by 27 publications

(32 citation statements)

References 4 publications

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“…While Xpert is a highly sensitive diagnostic for TB detection in lymph node samples and moderately sensitive for the detection of TB meningitis, our results show lower AL-ATEAH [14] ARMAND [15] CAUSSE [16] HANIF [19] HILLEMANN [20] MALBRUNY [22] MOURE [23] NHU [24] PATEL [25] SAFIANOWSKA [27] TORTOLI [28] VADWAI [29] ZEKA [31] [24] PATEL [25] TORTOLI [28] VADWAI [29] ZEKA [31] sensitivity for testing pleural fluid. Figure 6 shows the pooled sensitivity estimates for different sample types (pooled specificity estimates are online supplementary material).…”

Section: Discussionmentioning

confidence: 84%

“…Only four (25%) studies used the protocol (i.e. volume of sample included and sample reagent to sample ratio) recommended by the manufacturer [36] for unprocessed sputum samples [17,19,29,25] (table 2). Most of the studies that included a mechanical homogenisation step (40%) also performed a decontamination procedure with N-acetyl-L-cysteine and sodium hydroxide solution.…”

Section: Resultsmentioning

confidence: 99%

“…1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] that included 4461 samples. TB prevalence (based on culture) ranged from 0% to 81%.…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity was increased in studies with a low rate of HIV co-infection (49.5% compared with 40.6% in studies with .10% HIV) and in studies that used a concentration step (49.1% compared with 41.6% AL-ATEAH [14] ARMAND [15] CAUSSE [16] CHRISTOPHER [17] FRIEDRICH [18] HANIF [19] HILLEMANN [20] MALBRUNY [22] MOURE [23] PORCEL [26] SAFIANOWSKA [27] TORTOLI [28] VADWAI [29] ZEKA [31] without concentration step). A higher sensitivity was also observed for fresh samples (59.0%, 95% CI 41.0-76.9%) compared with frozen samples (31.4%, 95% CI 18.9-43.9%); however, the estimates for all of these subgroup analyses were imprecise and the confidence intervals were wide and overlapping.…”

Section: Detection Of Pleural Tbmentioning

confidence: 99%

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Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis

et al. 2014

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Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is endorsed for the detection of pulmonary tuberculosis (TB). We performed a systematic review and meta-analysis to assess the accuracy of Xpert for the detection of extrapulmonary TB.We searched multiple databases to October 15, 2013. We determined the accuracy of Xpert compared with culture and a composite reference standard (CRS). We grouped data by sample type and performed meta-analyses using a bivariate random-effects model. We assessed sources of heterogeneity using metaregression for predefined covariates.We identified 18 studies involving 4461 samples. Sample processing varied greatly among the studies. Xpert sensitivity differed substantially between sample types. In lymph node tissues or aspirates, Xpert pooled sensitivity was 83.1% (95% CI 71.4-90.7%) versus culture and 81.2% (95% CI 72.4-87.7%) versus CRS. In cerebrospinal fluid, Xpert pooled sensitivity was 80.5% (95% CI 59.0-92.2%) against culture and 62.8% (95% CI 47.7-75.8%) against CRS. In pleural fluid, pooled sensitivity was 46.4% (95% CI 26.3-67.8%) against culture and 21.4% (95% CI 8.8-33.9%) against CRS. Xpert pooled specificity was consistently .98.7% against CRS across different sample types.Based on this systematic review, the World Health Organization now recommends Xpert over conventional tests for diagnosis of TB in lymph nodes and other tissues, and as the preferred initial test for diagnosis of TB meningitis. @ERSpublications Xpert MTB/RIF can improve the diagnosis of lymph node TB and TB meningitis

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Section: Discussionmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

“…1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] that included 4461 samples. TB prevalence (based on culture) ranged from 0% to 81%.…”

Section: Resultsmentioning

confidence: 99%

Section: Detection Of Pleural Tbmentioning

confidence: 99%

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Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis

et al. 2014

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“…Some institutions may additionally perform the microscopically observed drug sensitivity (MODS) assay and/or very recently developed future science group GenXpert ® test (Cepheid, Sunnydale, CA, USA), since their benefit has been shown in terms of time-to-result compared with culture [55][56][57]. MODS is an inexpensive technique that can identify drug-resistant Mtb through direct drug susceptibility testing (DST) in liquid culture.…”

Section: Microbiological and Clinical Diagnosismentioning

confidence: 99%

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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Tuberculous meningitis (TBM) is the most severe form of TB. Despite treatment, mortality and long-term disability remain unacceptably high. Prevention, early recognition, diagnosis and treatment are fundamental to improving outcomes. However, an effective vaccine remains elusive, initial symptoms are nonspecific, and sensitive diagnostic tests are not available. There has been progress in our understanding of the immunopathology of TBM, and several factors have been found to be associated with susceptibility to infection, disease progression and clinical outcome. However, these have not yet impacted on treatment. Early treatment initiation and uninterrupted continuation, severity on presentation, seizures, stroke, cranial nerve involvement, cerebrospinal fluid cell count and lactate levels, hyponatreamia and coinfection with HIV are all found to be important prognostic factors for outcome. Pathogen lineage (Beijing genotype) and host genetics (polymorphisms in TLR2, TIRAP and LTA4H genes) can influence susceptibility to TBM. However, these findings have not yet impacted on treatment. Progress in vaccine development, opportunities for better diagnostic tests, novel insights into pathogenesis and an increasing evidence base for improving treatment should impact the current high mortality and morbidity, if translated to global and local guidelines.

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Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults

Steingart

Sohn

Schiller

et al. 2013

Cochrane Database of Systematic Reviews

320

260

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Background Accurate and rapid detection of tuberculosis (TB) and drug resistance are critical for improving patient care and decreasing the spread of TB. Xpert® MTB/RIF assay (Xpert) is a rapid, automated test that can detect both TB and rifampicin resistance, within two hours after starting the test, with minimal hands-on technical time, but is more expensive than conventional sputum microscopy. Objectives To assess the diagnostic accuracy of Xpert for pulmonary TB (TB detection), both where Xpert was used as an initial test replacing microscopy, and where Xpert was used as an add-on test following a negative smear microscopy result. To assess the diagnostic accuracy of Xpert for rifampicin resistance detection where Xpert was used as the initial test, replacing conventional culture-based drug susceptibility testing. The population of interest was adults suspected of having pulmonary TB or multidrug-resistant TB (MDR-TB), with or without HIV infection. Search methods We performed a comprehensive search of the following databases: Cochrane Infectious Diseases Group Specialized Register; MEDLINE; EMBASE; ISI Web of Knowledge; MEDION; LILACS; BIOSIS; and SCOPUS. We also searched the metaRegister of Controlled Trials (mRCT) and the search portal of the WHO International Clinical Trials Registry Platform to identify ongoing trials. We performed searches on 25 September 2011 and we repeated them on 15 December 2011, without language restriction. Selection criteria We included randomized controlled trials, cross-sectional, and cohort studies that used respiratory specimens to compare Xpert with culture for detecting TB and Xpert with conventional phenotypic drug susceptibility testing for detecting rifampicin resistance. Data collection and analysis For each study, two review authors independently extracted a set of data using a standardized data extraction form. When possible, we extracted data for subgroups by smear and HIV status. We assessed the quality of studies using the QUADAS-2 tool. We carried out meta-analyses to estimate the pooled sensitivity and specificity of Xpert separately for TB detection and rifampicin resistance detection using a bivariate random-effects model. We estimated the median pooled sensitivity and specificity and their 95% credible intervals (CrI). Main results We identified 18 unique studies as eligible for this review, including two multicentre international studies, one with five and the other with six distinct study centres. The majority of studies (55.6%) were performed in low-income and middle-income countries. In 17 of the 18 studies, Xpert was performed by trained technicians in reference laboratories. When used as an initial test replacing smear microscopy (15 studies, 7517 participants), Xpert achieved a pooled sensitivity of 88% (95% CrI 83% to 92%) and pooled specificity of 98% (9...

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GeneXpert® MTB/RIF for rapid detection of Mycobacterium tuberculosis in pulmonary and extra-pulmonary samples [Correspondence]

Cited by 27 publications

References 4 publications

Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis

Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults

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