Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF

Ullah, Irfan; Javaid, Arshad; Masud, Haleema; Ali, Mazhar; Basit, Anila; Ahmad, Waqas; Younis, F.; Yasmin, Rehana; Khan, Abdul Aziz; Jabbar, Abdul; Husain, Masroor; Butt, Zahid A

doi:10.1099/jmm.0.000449

Cited by 37 publications

(36 citation statements)

References 31 publications

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“…The results of our study are comparable to those a recent meta-analysis which reported the pooled sensitivity of Xpert in smear positive-culture positive PTB as 98%, and a sensitivity was 67% and specificity 99% for smear negative TB. [17] The results for the sensitivity of the Xpert MTB/RIF assay are also consistent with previous studies conducted in neighbouring countries; a study conducted in Pakistan by Ullah et al (2017), [18] who reported a sensitivity of 80.0%; in Korea by Lee [20,21,22] The Xpert MTB/RIF assay simultaneously identifies MTB and detects rifampicin resistance with molecular beacons to detect five overlapping 81-bp regions in the rpoB gene known as the rifampicin resistance determining region. [23] It has been shown that 95% of all rifampicin-resistant MTB strains contain mutations in the region of the rpoB gene.…”

Section: Discussionsupporting

confidence: 88%

Comparison Studies of GENXPERT versus MGIT Culture of Bronchial Lavage in Sputum Smear Negative Suspected Pulmonary Tuberculosis

Uppe¹,

Sharma²,

Sawant³

et al. 2018

AJIDM

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Introduction: Xpert MTB/RIF (Cepheid, USA) is an automated real-time PCR system that simultaneously detects TB and resistance to rifampicin. The test has excellent accuracy when performed on sputum and is endorsed by the World Health Organisation (WHO) and the USA Federal Drug Administration. Aims: To measure the diagnostic yield of bronchoalveolar lavage gene Xpert and compare it with traditional mycobacterial cultures in smear-negative and sputum-scarce pulmonary tuberculosis. Methods: A prospective observational study at a tertiary care hospital in India was conducted. A total of 200 patients who were 18 years or older under evaluation for clinico-radiological features of PTB with a history of a cough >2 weeks and a chest X-ray with pulmonary parenchymal involvement were recruited after ensuring two consecutive sputum negative smears or inability to produce adequate sputum. A volume of one ml of BAL sample was used to detect mycobacterium tuberculosis by the G4 version of Xpert ® MTB/RIF (Cepheid, USA) and by traditional mycobacterial cultures. cartridges without initial decontamination or centrifugation. Sensitivity, specificity and predictive values were calculated with 95% class intervals (CIs). McNemar's test was used for comparison of sensitivities. Result: The results showed that the AFB smear test had 76.83% (95% CI: 66.20-85.44) sensitivity, 100.0% (95% CI: 96.92-100.0) specificity with 100.% PPV and 86.13% (95%CI: 80.72-90.21) NPV compared to culture report.

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Section: Discussionsupporting

confidence: 88%

Comparison Studies of GENXPERT versus MGIT Culture of Bronchial Lavage in Sputum Smear Negative Suspected Pulmonary Tuberculosis

Uppe¹,

Sharma²,

Sawant³

et al. 2018

AJIDM

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“…In the present study, high sensitivity values were obtained with GX-Ultra in a large variety of extrapulmonary samples, and the results were superior to those of previous studies that applied Xpert MTB/RIF to similar specimens. The improvement was especially notable for lymph nodes, whose sensitivity increased between 17.1 and 23.5% more with GX-Ultra than with its predecessor (9,(18)(19)(20). Similarly, the nonsterile fluids obtained sensitivity values 15.7 to 27% higher with the novel assay than with Xpert MTB/RIF (9,19,20); in the case of tissue samples, the increase was 20 to 44.9% larger with the GX-Ultra (9,19).…”

Section: Discussionmentioning

confidence: 93%

Evaluation of the Xpert MTB/RIF Ultra Assay for Direct Detection of Mycobacterium tuberculosis Complex in Smear-Negative Extrapulmonary Samples

et al. 2018

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The rapid detection of complex (MTUBC) in clinical samples is essential for successful treatment. New techniques such as real-time PCR have been developed in order to facilitate rapid diagnosis, but their sensitivity is low in extrapulmonary specimens, due to the low bacillary load in such samples. A next-generation assay has recently been developed to try to overcome this limitation. The aim of this study was to analyze the effectiveness of the Xpert MTB/RIF Ultra (GX-Ultra) for the detection of MTUBC DNA in 108 smear-negative extrapulmonary specimens that were MTUBC culture positive. In addition, 40 extrapulmonary culture-negative samples and 20 samples with nontuberculous mycobacteria were tested to evaluate the specificity of the assay. All samples were collected between May 1999 and May 2017. The GX-Ultra detected DNA of MTUBC in 82 extrapulmonary specimens that were MTUBC culture positive (75.9% sensitivity; 95% confidence interval [CI], 66.6 to 83.4%). The assay was negative for all clinical specimens that were MTUBC culture negative and the samples with nontuberculous mycobacteria (100% specificity). Furthermore, two (1.8%) samples presented mutations related to rifampin resistance. The highest sensitivity was obtained in samples of lymph nodes (94.1%) and nonsterile fluids (93.7%), followed by tissue specimens (86.6%), stool material (80%), abscess aspirates (64.7%), and sterile fluids (60.5%). Pleural fluids, one of the least optimal samples for detecting DNA of MTUBC, were GX-Ultra positive in 10/21 (47.6%) of cases. In summary, GX-Ultra showed excellent specificity and high sensitivity in paubacillary specimens, making it a useful tool for rapid diagnosis of extrapulmonary tuberculosis.

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“…In comparison with the other commercially available NAATs, it is based on a fully-automated process (Theron et al, 2013;Le Palud et al, 2014;Boehme et al, 2010;World Health Organization, 2011;Sharma et al, 2015;Albert et al, 2016). Its diagnostic accuracy was widely confirmed on sputum specimens; however, in recent years its performance was successfully assessed on bronchoscopic specimens such as BW (Le Palud et al, 2014;Barnard et al, 2015;Lee et al, 2013;Ko et al, 2016;Sharma et al, 2015;Jo et al, 2016), BAL (Theron et al, 2013;Mok et al, 2016;Le Palud et al, 2014;Lee et al, 2013;Ko et al, 2016;Agrawal et al, 2016;Khalil and Butt, 2015;Sharma et al, 2015;Ullah et al, 2017), and endobronchial ultrasound guidedtransbronchial needle aspiration (EBUS-TBNA) (Dhasmana et al, 2014;Dhooria et al, 2016a;Lee et al, 2017) (Table 1).…”

Section: Bronchoalveolar Lavage and Bronchial Washing Aspiratementioning

confidence: 99%

Bronchoscopic techniques in the management of patients with tuberculosis

Mondoni

Repossi

Carlucci

et al. 2017

International Journal of Infectious Diseases

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Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).

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Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF

Abstract: The Xpert MTB/RIF assay is a rapid and simple technique with high sensitivity and specificity for diagnosing TB and detecting drug resistance in extrapulmonary and smear-negative TB cases.

Cited by 37 publications

References 31 publications

Comparison Studies of GENXPERT versus MGIT Culture of Bronchial Lavage in Sputum Smear Negative Suspected Pulmonary Tuberculosis

Comparison Studies of GENXPERT versus MGIT Culture of Bronchial Lavage in Sputum Smear Negative Suspected Pulmonary Tuberculosis

Evaluation of the Xpert MTB/RIF Ultra Assay for Direct Detection of Mycobacterium tuberculosis Complex in Smear-Negative Extrapulmonary Samples

Bronchoscopic techniques in the management of patients with tuberculosis

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