Role of gene Xpert MTB/ RIF assay in diagnosis of Tubercular Pleural Effusion

Shukla, Amarendra Kumar; Kajal, Nirmal Chand; Malhotra, Balbir; Gupta, Sandeep; P.S, Nishanth .; Singh, Ashi; Neki, N.S.

doi:10.22192/ijcrms.2017.03.05.015

Cited by 10 publications

(12 citation statements)

References 9 publications

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“…The most common presenting symptom is cough (85%) in the study, similar to that of Anushree Chakraborthy et al (89%), Lokeswara Reddy et al 11 (73.3%) whereas the most common presenting symptom is a fever in Shukla et al 12 and Sachin kate et al The second most common symptom in our study is chest pain (78%), similar to Sharma et al study(71.5%). In the present study, fever accounts for (68%), which is comparable to Lokeswarareddy et al(70%).…”

Section: Discussionsupporting

confidence: 87%

Role of ADA and CBNAAT(Cartridge Based Nucleic Acid Amplification Test) in diagnosis of Tuberculosis in straw coloured exudative pleural effusion in patients attending Government General Hospital, KAKINADA

Srinidhi¹,

Mathangi²,

Kumar³

2020

IJIRM

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India is presently one of the high burden countries for tuberculosis and accounts for 23% of global TB burden with 2.2 million patients. Of these reported cases in India around 20% are of Extra Pulmonary Tuberculosis (EPTB).Pleural effusion due to TB is currently the second common location for EPTB next to TB lymphadenitis . The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. The present study was done to determine the role of ADA and CBNAAT both being rapid and non-invasive diagnostic methods for early detection of tuberculous pleuritis, which is essential for treatment initiation, improved patient outcome and for more effective public health intervention. Materials and Methods: An observational study was done on 100 patients presenting with clinicoradiological picture suggestive of pleural effusion, either admitted or attending OPD of Department of Pulmonary Medicine from Nov 2017 to Nov 2019 at GGH, Kakinada. Results: Out of 100 exudative pleural effusions in study, male predominance with 80% of males and 20% females. Lymphocyte predominance is 74%, sputum AFB was positive in 6 cases. With ADA cut off as 40IU/L, 70 cases had an ADA > 40IU/L out of which 64 were tubercular, and 6 were malignant effusions .ADA has a sensitivity of 94% and specificity of 60%.Pleural fluid CBNAAT was positive in 30 cases, out of which 2 cases had an ADA < 40 IU/L .All are rifampicin sensitive. The sensitivity of CBNAAT is 40% and specificity 82%.There is a positive correlation between the lymphocyte predominance with ADA and CBNAAT with P<0.05%. Conclusion: Estimation of ADA in pleural fluid is a simple, rapid, and less expensive laboratory investigation where the diagnosis is uncertain. The sensitivity of ADA, when combined with lymphocytepredominant exudates, helps to diagnose tubercular effusions. The role of CBNAAT in diagnosing pleural TB is limited due to its poor sensitivity.

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Section: Discussionsupporting

confidence: 87%

Role of ADA and CBNAAT(Cartridge Based Nucleic Acid Amplification Test) in diagnosis of Tuberculosis in straw coloured exudative pleural effusion in patients attending Government General Hospital, KAKINADA

Srinidhi¹,

Mathangi²,

Kumar³

2020

IJIRM

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“…Rifampicin resistance was detected in 21% of cases. They found a positive correlation with high ADA values, pleural fluid lymphocyte counts and MTB detection by genexpert (r = 0.92, r = 0.97, respectively with p < 0.05) [10].…”

Section: Discussionmentioning

confidence: 93%

The Role of Genexpert in the Diagnosis of Tubercular Pleural Effusion in India

Chakraborty

Ramaswamy

Shivananjiah

et al. 2019

Advances in Respiratory Medicine

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Introduction: Tubercular pleural effusion is the second most common extrapulmonary form of tuberculosis in India. Developing nations like India face several health challenges and with limited resources, appropriate planning and channelization of the same is the need of the hour. Material and methods: The objective of the study was to determine the role of cartridge-based nucleic acid amplification test (CBNAAT) in the diagnosis of tubercular pleural effusion (TPE) and also to study if any association exists between CBNAAT and pleural fluid adenosine deaminase (ADA) and lymphocyte counts. Clinically suspected TPE, lymphocyte predominant (≥ 70%) exudates (according to the Lights criteria) with ADA ≥ 40 U/L and microbiologically confirmed pulmonary tuberculosis patients with a co-existent pleural effusion were included. Pleural fluid CBNAAT was performed on all the samples. Results: Out of a total of 75 patients, 57 were males and 18 were females. A lymphocyte predominance of ≥ 70% was seen in 73 subjects (97%). Mean ADA was 61.7 U/L ± 16.2 (SD). Pleural fluid CBNAAT was positive for Mycobacterium tuberculosis (MTB) in 24 patients (32%). Out of these patients, rifampicin resistance was detected in 2 individuals (8.3%). Sputum smear for acid fast bacilli (AFB) was positive in 3 (4%) patients, whereas in sputum CBNAAT MTB was detected in 8 (10.6%) persons. Association between pleural fluid ADA, lymphocyte count and CBNAAT positivity was evaluated by Student T-test. There was a significant association between higher ADA levels and CBNAAT (p value = 0.001). Conclusions: Pleural fluid CBNAAT, owing to its low sensitivity, should not be included in the diagnostic protocol of TPE in high prevalence areas. A high ADA ≥ 40 U/L in combination with Light's criteria to define exudates, with lymphocyte predominance is sufficient evidence to diagnose TPE and initiate anti-tubercular therapy, thereby deferring the need to perform an invasive pleural biopsy.

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“…AFB staining was negative in all the cases. The culture was done in a few cases 16 and was negative.…”

Section: Resultsmentioning

confidence: 99%

A Prospective Study for comparison of diagnostic utility of Gene XPERT MTB/RIF Assay, adenosine deaminase and cytology in Tuberculous Pleural Effusion

Garg¹,

Agarwal²,

Gupta³

et al. 2020

ACHR

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Tubercular pleural effusion is the second most common extrapulmonary form of tuberculosis in India. It poses several health challenges in a developing country like India which has limited resources, for developing appropriate methods to diagnose. Aim: The objective of the study was to determine the role of cartridge-based nucleic acid amplification test (CBNAAT) in the diagnosis of tubercular pleural effusion (TPE) and compare it with the diagnostic utility of Adenosine Deaminase (ADA) and lymphocyte counts in pleural fluid. Methods: Total 100 patients were selected from July 2019 to December 2019. Pleural fluid was collected in sterile container. Gene/xpert, Adenosine deaminase, total leukocytes count and lymphocytes percentage were evaluated. Results: It was found that high leukocytes count and lymphocyte predominance was present in >80% of the patient. Mean ADA was 68.7 U/L ± 13.2 (SD). CBNAAT was positive in 30 patients. Acid fast bacilli stain was negative in the entire patient. Conclusion:The usefulness of Xpert MTB/RIF to diagnose pleural TB is limited by its poor sensitivity. A high ADA ≥ 40 U/L in combination with Light's criteria to define exudates, with lymphocyte predominance is sufficient evidence to diagnose tuberculous pleural effusion and initiate anti-tubercular therapy, thereby deferring the need to perform an invasive pleural biopsy.

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Role of gene Xpert MTB/ RIF assay in diagnosis of Tubercular Pleural Effusion

Cited by 10 publications

References 9 publications

Role of ADA and CBNAAT(Cartridge Based Nucleic Acid Amplification Test) in diagnosis of Tuberculosis in straw coloured exudative pleural effusion in patients attending Government General Hospital, KAKINADA

Role of ADA and CBNAAT(Cartridge Based Nucleic Acid Amplification Test) in diagnosis of Tuberculosis in straw coloured exudative pleural effusion in patients attending Government General Hospital, KAKINADA

The Role of Genexpert in the Diagnosis of Tubercular Pleural Effusion in India

A Prospective Study for comparison of diagnostic utility of Gene XPERT MTB/RIF Assay, adenosine deaminase and cytology in Tuberculous Pleural Effusion

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