Higher-than-expected prevalence of non-tuberculous mycobacteria in HIV setting in Botswana: Implications for diagnostic algorithms using Xpert MTB/RIF assay

Agizew, Tefera; Basotli, Joyce; Alexander, Heather; Boyd, Rosanna; Letsibogo, Gaoraelwe; Auld, Andrew F.; Nyirenda, Sambayawo; Tedla, Zegabriel; Mathoma, Anikie; Mathebula, Unami; Pals, Sherri; Date, Anand; Finlay, Alyssa

doi:10.1371/journal.pone.0189981

Cited by 25 publications

(29 citation statements)

References 27 publications

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“…Although there have been suggestions that certain nontuberculous mycobacterial species (e.g. M malmoense ) may give false‐positive Xpert MTB/RIF results due to weak cross hybridization ( Agizew 2017 ), the false‐positive rate in specimens culture‐positive for NTM was similar to the overall frequency of false positives.…”

Section: Discussionmentioning

confidence: 99%

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

Horne

Kohli

Zifodya

et al. 2019

Cochrane Database of Systematic Reviews

182

157

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Background Xpert MTB/RIF (Xpert MTB/RIF) and Xpert MTB/RIF Ultra (Xpert Ultra), the newest version, are the only World Health Organization (WHO)‐recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in persons with signs and symptoms of tuberculosis, at lower health system levels. A previous Cochrane Review found Xpert MTB/RIF sensitive and specific for tuberculosis ( ). Since the previous review, new studies have been published. We performed a review update for an upcoming WHO policy review. Objectives To determine diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB) and for rifampicin resistance in adults with presumptive rifampicin‐resistant tuberculosis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, to 11 October 2018, without language restriction. Selection criteria Randomized trials, cross‐sectional, and cohort studies using respiratory specimens that evaluated Xpert MTB/RIF, Xpert Ultra, or both against the reference standard, culture for tuberculosis and culture‐based drug susceptibility testing or MTBDR plus for rifampicin resistance. Data collection and analysis Four review authors independently extracted data using a standardized form. When possible, we also extracted data by smear and HIV status. We assessed study quality using QUADAS‐2 and performed meta‐analyses to estimate pooled sensitivity and specificity separately for tuberculosis and rifampicin resistance. We investigated potential sources of heterogeneity. Most analyses used a bivariate random‐effects model. For tuberculosis detection, we first estimated accuracy using all included studies and then only the subset of studies where participants were unselected, i.e. not selected based on prior microscopy testing. Main results We identified in total 95 studies (77 new studies since the previous review): 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen. Tuberculosis detection Of the total 86 studies, 45 took place in high tuberculosis burden and 50 in high TB/HIV burden countries. Most studies had low risk of bias. Xpert MTB/RIF pooled sensitivity and specificity (95% credible Interval (CrI)) were 85% (82% to 88%) and 98% (97% to 98%), (70 studies, 37,237 unselected participants; high‐certainty evidence). We found similar accuracy when ...

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Section: Discussionmentioning

confidence: 99%

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

Horne

Kohli

Zifodya

et al. 2019

Cochrane Database of Systematic Reviews

182

157

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“… 5 , 15 Since the roll out of Xpert, studies in Botswana have shown that greater than half of positive sputum cultures among people living with HIV with a positive WHO symptom screen show non-tuberculous mycobacteria (NTM), demonstrating a significant limitation with reliance upon smear microscopy for diagnosis of TB, such as in our study. 17 Furthermore, our findings that TB was diagnosed no sooner with positive sputum smear raises concern for potential problems along the TB care cascade, such as laboratory delays, paucity of sputum sample collection, or clinician anchoring bias to CAP diagnosis.…”

Section: Discussionmentioning

confidence: 87%

Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

Gersh

Feldman

Greenberger

et al. 2018

J Public Health Afr

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Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP). The aim of this paper was to determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana. We performed a retrospective study of adults presenting with CAP from April 2010-October 2011 to the Emergency Department (ED); we matched this cohort to the National Botswana Tuberculosis Registry (NBTR) to identify individuals subsequently diagnosed with TB. We assessed demographics, time to TB diagnosis, clinical outcomes and performed logistic regressions to identify factors associated with TB diagnosis. We identified 1305 individuals presenting with CAP; TB was subsequently diagnosed in 68 (5.2%). The median time to TB diagnosis was 9.5 days. Forty percent were AFB sputum smear positive and 87% were identified as being HIV-positive. Subsequent diagnosis of TB is common among individuals with CAP at our ED, suggesting that TB may be present at the time of CAP presentation. Given the lack of distinguishing clinical factors between pulmonary TB and CAP, adults presenting with CAP should be evaluated for active TB in Botswana.

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“…In a study conducted by Shao, et al, (2015) [6] in China the prevalence of NTM was 3.37% among 1779 smear positive clinical isolates. However, reports from some sub-Saharan settings have been indicating that the prevalence of NTM among mycobacteria culture positive ranges from 4 to 9% [1]. Furthermore, a prospective study conducted in Nigeria reported that the prevalence of NTM among tuberculosis suspects was 15.5% [7].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies conducted in Zambia and Botswana have shown an increase in females than males. According to them they suggested that the number could have been small in males because men delay in seeking care or un willing to seek care [1,10]. The ndings vary geographically due to different predisposing factors such as immune status, occupation and life style and possibly climatic conditions.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Distribution of Non – Tuberculous Mycobacteria (NTM) Among MDR-TB Suspected Patients in Northern Malawi

Mabaso¹,

Ngwira²,

Kamudumuli³

et al. 2020

Preprint

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BackgroundNon-tuberculosis Mycobacteria (NTM) are increasingly being recognized as human pathogens, causing substantial morbidity and mortality in progressive lung disease, immunosuppressed, the elderly and the youth. Similarity of clinical symptoms with MTB, coupled with limited diagnostic capacities in tuberculosis (TB) endemic developing countries has led to misdiagnosis of NTM pulmonary disease. The study aimed at establishing the prevalence and distribution of NTM among Multi-Drug Resistance Tuberculosis (MDR-TB) suspected patients in Northern Region of Malawi based on laboratory culture records from 2015 to 2018 conducted at Mzuzu Central Hospital.MethodsThe study used a retrospective cross-sectional design. All culture positive underwent MTB confirmatory test using the SD-Bio line TB Ag MPT64 Kit to confirm MTB or to suspect for NTM. Data was analysed for descriptive statistics in SPSS version 20 and presented using frequency tables, charts and graphs.Results Out of 170 culture positive reports reviewed, 30 (18%) were NTM. Much as there were generally more males (69.4%) who were MDR-TB suspected patients, the proportion of NTM patients was female predominant 13/52 (25%) as compared to 17/118 (14%) for males while the age range of 30-49 was the most (22%) affected. Twenty-nine (97%) of the NTM cases were previously treated for MTB.ConclusionsThe high prevalence of NTM among MDR-TB suspected patients shows that the disease is a serious public health problem. This therefore calls for urgent attention from Ministry of Health and partners, health workers and all stakeholders involved in policy making so that NTM diagnosis should have a clear algorithm to avoid wastage a of resources as well as for good patient care.

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Higher-than-expected prevalence of non-tuberculous mycobacteria in HIV setting in Botswana: Implications for diagnostic algorithms using Xpert MTB/RIF assay

Cited by 25 publications

References 27 publications

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

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

Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

Prevalence and Distribution of Non – Tuberculous Mycobacteria (NTM) Among MDR-TB Suspected Patients in Northern Malawi

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