The role of the Xpert MTB/RIF assay among adolescents suspected of pulmonary tuberculosis in Rio de Janeiro, Brazil

Sieiro, Thania Luiza de Andrade; Aurílio, Rafaela Baroni; Soares, Elizabeth; Chiang, Silvia S.; ́Anna, Clemax Couto Sant

doi:10.1590/0037-8682-0298-2017

Cited by 11 publications

(8 citation statements)

References 10 publications

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“…Among the adolescents included in the present study, Xpert positivity was observed to be 35%, which is higher than 15.7% found in the study conducted in Rio de Janeiro City 16 , which included adolescents with ITB symptoms, in the year of the implementation of the laboratory method as routine procedure in TB bacteriological identification. Lower Xpert performance was expected since any person to be evaluated for ITB was included in the study, regardless of their epidemiological history, laboratory results, and chest radiograph imaging results.…”

Section: /6contrasting

confidence: 70%

The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers

Aurílio

Luiz

Land

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: The diagnostic accuracy of Xpert MTB/RIF (Xpert) in pulmonary tuberculosis (PTB) in children is lower than in adults. In Brazil, the diagnosis of PTB is based on a diagnostic score system (DSS). This study aims to study the role of Xpert in children and adolescents with PTB symptoms. Methods: A cross-sectional study was conducted in 3 referral centers to TB. Children and adolescents (0-19 years old) whose respiratory samples were submitted to Xpert were included. Statistical analysis (bivariate and logistic regression) to assess the simultaneous influence of TB-related variables on the occurrence of Xpert detectable in TB cases was done. To evaluate the agreement or disagreement between Xpert results with acid-fast bacillus (AFB) and cultures, κ method was used (significancy level of 5%). Results: Eighty-eight patients were included in the study and PTB occurred in 43 patients (49%) and Xpert was detectable in 21 patients (24%). Adolescents and positive culture results were independent predictive variables of Xpert positivity. DSS sensitivity compared with the final diagnosis of TB was 100% (95% CI, 88.1-100%), specificity was 97.2% (95% CI, 85.5-99.9%). The accuracy of the method was 98.5% (95% CI, 91.7-99.9%). Conclusions: Xpert contributed to diagnosis in 9% of patients with AFB and in culture negative cases. DSS indicated relevance for this diagnostic approach of intrathoracic TB (ITB) in reference centers for presenting data both with high sensitivity and specificity.

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Section: /6contrasting

confidence: 70%

The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers

Aurílio

Luiz

Land

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…It can process different materials, but its most excellent applicability is in the sputum of adults with suspected pulmonary TB (PTB) 2 . The positivity in adolescents (16%) was similar to adults in Rio de Janeiro, Brazil 3 . The Ministry of Health of Brazil recommends Xpert in the following specimens: sputum, induced sputum, bronchoalveolar lavage, gastric lavage, cerebrospinal fluid, lymph nodes, and tissue macerates 2 .…”

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confidence: 55%

The use of Gene-Xpert MTB RIF in the diagnosis of extrapulmonary tuberculosis in childhood and adolescence

Aurílio

Marsili

Malaquias

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: Gene-Xpert MTB RIF (Xpert) is based on nucleic acid amplification by real-time polymerase chain reaction, which allows for the identification of Mycobacterium tuberculosis and rifampin resistance. We describe the use of Xpert for extrapulmonary tuberculosis (EPTB) in children and adolescents. Methods: A case series of two reference centers in Rio de Janeiro from 2014-2019. Results: The final diagnosis of EPTB was established in 11/36 (31%) patients, with five cases detectable by Xpert. For lymph node evaluation (9/11), diagnosis by Xpert occurred in 5/9 patients, all with caseous aspects. Conclusions: Xpert can facilitate the rapid diagnosis of lymph node tuberculosis.

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“…There is still a lack of information about Xpert performance under programmatic conditions in Brazil despite its regular use in many high-burden cities since 2014 [5]. Recent studies in Brazil showed that the use of the Xpert MTB/RIF increased detection of TB cases among paucibacillary patients [14], adolescents [15] and the HIV-positive population [16].…”

Section: Discussionmentioning

confidence: 99%

Xpert MTB/RIF performance to diagnose tuberculosis and rifampicin resistance in a reference centre in southern Brazil

et al. 2019

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Effective treatment of tuberculosis (TB) remains a serious public health problem in many countries, including Brazil, especially when considering drug-resistant disease. Xpert MTB/RIF has been implemented in many countries to reduce the time to TB diagnosis and to rapidly detect rifampicin resistance. The study aimed to describe and evaluate Xpert MTB/RIF performance in diagnosing pulmonary TB and rifampicin resistance in a tertiary healthcare facility in Brazil.A cross-sectional study was performed, which included all isolates of confirmed pulmonary TB patients from 2015 to 2018. Both Xpert MTB/RIF and GenoType MTBDRplus assays were performed to detect rifampicin and isoniazid resistance. In addition, isolates with detected resistance to rifampicin and/or isoniazid were analysed by phenotypic testing using MGIT-960 SIRE kit and whole-genome sequencing (WGS) using Illumina MiSeq Sequencing System.2148 respiratory specimens tested with Xpert MTB/RIF were included: n=1556 sputum, n=348 bronchoalveolar lavage and n=244 gastric washing. The overall Xpert MTB/RIF sensitivity in sputum was 94% and the overall specificity was 98%. The negative predictive value in sputum of all the patients was 99% with a positive predictive value of 89%. The concordance between Xpert MTB/RIF and phenotypic susceptibility test was 94.1%, while its concordance with WGS was 78.9%.Xpert MTB/RIF is a rapid and accurate diagnostic strategy for pulmonary TB, which can contribute to improvement in TB control. However, detection of rifampicin resistance might be associated with false-positive results.

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The role of the Xpert MTB/RIF assay among adolescents suspected of pulmonary tuberculosis in Rio de Janeiro, Brazil

Abstract: Among suspected cases, 16% were diagnosed by TRM-TB, of which 17% were drug-resistant by DST.

Cited by 11 publications

References 10 publications

The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers

The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers

The use of Gene-Xpert MTB RIF in the diagnosis of extrapulmonary tuberculosis in childhood and adolescence

Xpert MTB/RIF performance to diagnose tuberculosis and rifampicin resistance in a reference centre in southern Brazil

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