Xpert MTB/RIF Assay as a Substitute for Smear Microscopy in an Intermediate-Burden Setting

Lee, Hyunseung; Kee, Seung‐Jung; Shin, Ju-Hyeon; Kwon, Yong Soo; Chun, Sejong; Lee, Jun Hyung; Won, Eun Jeong; Choi, Hyun‐Jung; Kim, Soo Hyun; Shin, Myung‐Geun; Shin, Jong‐Hee; Suh, Soon Pal

doi:10.1164/rccm.201804-0654oc

Cited by 41 publications

(34 citation statements)

References 19 publications

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“…Nevertheless, contact tracing based on threshold cycle ( C T ) value or semiquantitative result of molecular tests are still needed to make a direct link between DNA burden and transmission potential. Similar results have been observed in different TB burden settings, suggesting that semiquantitative molecular tests could replace smear microscopy to initiate pulmonary TB diagnosis and treatment as well as to guide airborne isolation strategies (1, 5). Based on these findings, we maintained a smear-independent algorithm based initially on Xpert and now on Ultra to initiate the diagnosis of pulmonary tuberculosis (4).…”

Section: Discussionsupporting

confidence: 69%

“…Xpert displays reduced turnaround time and shortened patient isolation and time to initiate anti-TB drugs and is more sensitive and specific than smear microscopy for acid-fast bacillus (AFB) detection. This test is now recommended to initiate the microbial diagnosis of tuberculosis (1–3), as well as to address patient’s transmission potential based on the semiquantitative result (1, 4, 5). Despite a very low limit of detection (LOD; ∼131 CFU/ml), Xpert remains less sensitive than liquid culture (LOD ∼1 to 50 CFU/ml) (6).…”

Section: Introductionmentioning

confidence: 99%

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Added Value of Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting

et al. 2019

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Added Value of Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting

et al. 2019

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“…On the other hand, some strengths of our study should be mentioned. The hospital's mycobacterial laboratory is staffed by specialized technicians in all stages of the process, with 1 professional performing AFB smears, which demonstrates higher sensitivity values than other studies, such as Lee et al, 19 who demonstrated AFB smear sensitivity of 38%. Also, the clinicallaboratory relationship in our hospital favors the implementation of protocols and process improvements.…”

Section: Discussionmentioning

confidence: 98%

Decision making to discharge patients from airborne infection isolation rooms: The role of a single GeneXpert MTB/RIF strategy in Brazil

Menon

Feliciano

Campos

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation.Methods:In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears.Results:We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory specimens. GeneXpert MTB/RIF demonstrated good performance compared to AFB smear to rule out TB in all groups. The negative predictive value for AFB smear was 94% (95% confidence interval [CI], 0.90–0.97) and 98% (95% CIs, 0.94–0.99) for GeneXpert MTB/RIF in G3. The isolation discharge based on 3 AFB smears took 84 hours compared to 24 hours with GeneXpert MTB/RIF, which represents 560 patient-days saved in the isolation rooms.Conclusion:A single GeneXpert MTB/RIF is a fast and strong predictor for TB absence in a high-complexity hospital, which is quite similar to results obtained in recent studies in low-burden settings. This molecular test may also increase patient rotation through isolation rooms, with a positive impact in the emergency room and infectious diseases wards.

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“…These results are in accordance with previous publications. [10][11][12] Furthermore, regardless of HIV status, we found that Xpert C T values negatively correlated with plasma CRP levels (P = 0.002, r = −0.52 for HIV− and P = 0.0004, r = −0.57 for HIV+; Fig. 1c) and the Timika radiographic severity score (P = 0.0002, r = −0.61 for HIV− and P < 0.004, r = −0.48 for HIV+; Fig.…”

Section: Study Populationmentioning

confidence: 99%

Mycobacterium tuberculosis-specific CD4 T cells expressing CD153 inversely associate with bacterial load and disease severity in human tuberculosis

et al. 2021

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Recent data from mice and non-human primate models of tuberculosis suggested that CD153, a TNF super family member, plays an important role in Mycobacterium tuberculosis (Mtb) control. However, this molecule has not been comprehensively evaluated in humans. Here, we show that the proportion of Mtb-specific CD4 T cells expressing CD153 was significantly reduced in active TB patients compared to latently infected persons. Importantly, the CD153+ Mtb-specific CD4 response inversely correlated with lung bacterial load, inferred by Xpert cycle threshold, irrespective of HIV status. Antitubercular treatment partially restored CD153 expression on Mtb-specific CD4 T cells. This is the first report of a subset of Mtb-specific CD4 T cells showing strong negative correlation with bacterial burden. Building on substantial evidence from animal models implicating CD153 as a mediator of host protection, our findings suggest it may play a similar role in humans and its measurement may be useful to evaluate TB vaccine efficacy.

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Xpert MTB/RIF Assay as a Substitute for Smear Microscopy in an Intermediate-Burden Setting

Cited by 41 publications

References 19 publications

Added Value of Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting

Added Value of Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting

Decision making to discharge patients from airborne infection isolation rooms: The role of a single GeneXpert MTB/RIF strategy in Brazil

Mycobacterium tuberculosis-specific CD4 T cells expressing CD153 inversely associate with bacterial load and disease severity in human tuberculosis

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