Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource- constrained Setting: State of the Art, Challenges and the Need

Purohit, Manju; Mustafa, Tehmina

doi:10.7860/jcdr/2015/12422.5792

Cited by 125 publications

(149 citation statements)

References 20 publications

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“…Also, definitive diagnosis becomes difficult due to paucibacillary nature of TB bacilli in extra-pulmonary specimens. 30 In the present study, the combined sensitivity of Xpert MTB/RIF assay was 88.14%. A systematic review and meta-analyses conducted by Denkingeret al 31 showed that Xpert MTB/RIF assay has a sensitivity ranging from 50% to 100% with pooled sensitivity of 83%.…”

Section: Discussionmentioning

confidence: 43%

Performance of Xpert MTB/Rif Assay for Detection of M.TB in Pulmonary and Extra-Pulmonary Samples in Indian Patients

Shetye¹,

Chheda²,

Lad,³

et al. 2017

SAARC J. Tuber. Lung Dis. HIV/AIDS

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Introduction: Conventional methods like Ziehl-Neelsen (ZN) staining and liquid culture have been the mainstay for diagnosis of Tuberculosis (TB). The gold standard Liquid Culture method has a longer turnaround time. In the wake of the TB catastrophe, newer rapid and easily accessible methods of detection are the need of the hour. A molecular method like the Xpert MTB/RIF assay has revolutionized the early and rapid diagnosis of TB. Objective of the current study was to assess the performance and utility of Xpert MTB/RIF assay for the diagnosis of M. tuberculosis in pulmonary and extra-pulmonary clinical specimens in a large Indian reference laboratory.Methodology: The reference methods used were MGIT Liquid Culture system and ZN smear microscopy. Our study was performed in Global Reference Laboratory, Metropolis Healthcare, Mumbai, India for a period of 18 months with consecutive one thousand and forty two (518 Pulmonary + 524 extra-pulmonaryspecimens) clinical specimens obtained from the patients with clinical suspicion of tuberculosis. Diagnostic performance (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the three methods were calculated with standard formulae.Results: In comparison to MGIT Liquid culture, sensitivity of Xpert MTB/RIF assay for pulmonary and extra pulmonary specimens were 87.18% and 68.92%, respectively while in comparison to ZN smear microscopy the sensitivity of Xpert MTB/RIF assay for pulmonary and extra pulmonary specimens were 92.67% and 83.81%, respectively.Conclusion: Our study concludes that in combination with the MGIT culture, Xpert MTB/RIF assay will significantly improve the detection rate of MTB bacteria.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 7-13

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Section: Discussionmentioning

confidence: 43%

Performance of Xpert MTB/Rif Assay for Detection of M.TB in Pulmonary and Extra-Pulmonary Samples in Indian Patients

Shetye¹,

Chheda²,

Lad,³

et al. 2017

SAARC J. Tuber. Lung Dis. HIV/AIDS

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“…Also, the results of the tests assessing TB infection such as tuberculin skin test or interferon-gamma release assays may be misleading. 8 Secondly, routine cytology and histology cannot distinguish between the diseases caused by TB or non-TB mycobacterium, or chronic inflammatory conditions. TB, thus, remains undiagnosed in 20% cases even after multiple biopsies or aspirations.…”

Section: Introductionmentioning

confidence: 99%

Rapid and Specific Diagnosis of Extrapulmonary Tuberculosis by Immunostaining of Tissues and Aspirates With Anti-MPT64

Purohit

Sviland

Wiker

et al. 2017

Applied Immunohistochemistry &Amp; Molecular Morphology

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Background: Extrapulmonary tuberculosis (EPTB) constitutes about 15% to 20% of all cases of tuberculosis (TB). The confirmation of EPTB has always been a challenge to laboratory personnel. We aim to evaluate the diagnostic potential of immunostaining with anti-MPT64 in various EPTB specimens. Materials and Methods:We studied a total of 51 TB cases and 38 non-TB control specimens comprising of fine-needle aspirates and formalin-fixed biopsies. These were investigated using a combination of the Ziehl-Neelsen method, the Lowenstein-Jensen culture, immunostaining with anti-MPT64 and anti-BCG, and nested-polymerase chain reaction (PCR) for IS6110. Results of all the tests were compared using nested-PCR as the gold standard.Results: Diagnostic validation of immunostaining for anti-MPT64 was performed using nested-PCR as the gold standard. The overall sensitivity, specificity, and positive and negative predictive values for immunostaining with anti-MPT64 were 100%, 97%, 97%, and 100%, respectively. Conclusions:Immunostaining using anti-MPT64 is a rapid and sensitive method for establishing an early and specific diagnosis of Mycobacterium tuberculosis infection. The technique is simple to be incorporated into routine pathology laboratories.

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“…Findings of the study supported the use of GeneXpert MTB/RIF assay in routine diagnosis for EPTB investigation, especially for pus samples. 8,9 Similar studies were carried out by Lawn and Zumla 10 who employed the GeneXpert MTB/RIF assay for diagnosis of EPTB. Out of the total of 268 samples, the positivity rate was observed for tissue biopsies or fine-needle aspirates (35%), gastric aspirates (23%), pus (21%), urine (6%), cerebrospinal fluid (5%), and other body fluids, i.e., peritoneal, synovial, and pericardial (4%).…”

Section: Discussionmentioning

confidence: 81%

Utility of GeneXpert Mycobacterium tuberculosis/Rifampin Assay for Extrapulmonary Tuberculosis Samples

Shetye¹,

Yadav²,

Chheda³

et al. 2017

MGM Journal of Medical Sciences

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A total of 3,806 samples from suspected cases of extrapulmonary tuberculosis (EPTB) were subjected to GeneXpert Mycobacterium tuberculosis (MTB)/rifampin (RIF) assay. Samples consisted of body fluids, pleural fluids, pus and aspirates, lymph node (LN) tissues, and others. Mycobacterium tuberculosis positivity was detected in 18.10% and RIF positivity in 2.73% samples. The MTB/RIF positivity was found highest in pus and aspirates (40.38%). In this study, assay failure rate for GeneXpert MTB/RIF assay was very low (1.99%). It is concluded from this study that GeneXpert MTB/RIF is an efficient, reliable, simple, and fast technique for rapid diagnosis of EPTB in our country where incidence of tuberculosis remains high.

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Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource- constrained Setting: State of the Art, Challenges and the Need

Cited by 125 publications

References 20 publications

Performance of Xpert MTB/Rif Assay for Detection of M.TB in Pulmonary and Extra-Pulmonary Samples in Indian Patients

Performance of Xpert MTB/Rif Assay for Detection of M.TB in Pulmonary and Extra-Pulmonary Samples in Indian Patients

Rapid and Specific Diagnosis of Extrapulmonary Tuberculosis by Immunostaining of Tissues and Aspirates With Anti-MPT64

Utility of GeneXpert Mycobacterium tuberculosis/Rifampin Assay for Extrapulmonary Tuberculosis Samples

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