1887

Abstract

Xpert/rifampicin (Xpert MTB/RIF) assay has been endorsed by the World Health Organization (WHO) for diagnosis of extrapulmonary tuberculosis (EPTB), while the sensitivity and specificity have not been fully evaluated. We aimed to evaluate the performance of Xpert MTB/RIF assay in the detection of different extrapulmonary specimens.

A total of 420 nonrespiratory specimens were detected with acid-fast bacilli (AFB) smear microscopy, solid culture, conventional drug susceptibility testing (DST) and Xpert MTB/RIF assay. Using solid culture and conventional DST as the gold standard, we assessed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the Xpert MTB/RIF assay for detecting MTB and rifampin resistance, respectively.

When setting the solid culture results as the gold standard, the sensitivity, specificity, PPV, NPV and value of Xpert MTB/RIF assay and AFB smear results were 70.6 % (48/68), 91.96 % (318/346), 63.2 % (48/76), 94.1 % (318/338), 0.60, respectively. In addition, when compared with conventional DST results, the sensitivity, specificity, PPV, NPV and of the Xpert MTB/RIF assay for detecting rifampin resistance were 91.7 % (11/12), 100.0 % (47/47), 100.0 % (11/11), 97.9 % (47/48) and 0.95, respectively.

Compared with AFB smear and solid culture, Xpert MTB/RIF assay has high sensitivities and short detection time, so could be used as an alternative for the rapid diagnosis of EPTB and rifampin resistance in clinical practice.

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2017-07-01
2024-03-29
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References

  1. World Health Organization Global Tuberculosis Report 2015 Geneva, Switzerland: World Health Organization; 2015
    [Google Scholar]
  2. Zhao Y, Xu S, Wang L, Chin DP, Wang S et al. National survey of drug-resistant tuberculosis in China. N Engl J Med 2012; 366:2161–2170 [View Article][PubMed]
    [Google Scholar]
  3. Liu JJ, Yao HY. Epidemic status and control measures of tuberculosis in China (in Chinese). Preventive Medicine Tribune 2006; 5:638–640
    [Google Scholar]
  4. Lawn SD, Zumla AI. Diagnosis of extrapulmonary tuberculosis using the Xpert®MTB/RIF assay. Expert Rev Anti Infect Ther 2012; 10:631–635 [View Article][PubMed]
    [Google Scholar]
  5. Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010; 363:1005–1015 [View Article][PubMed]
    [Google Scholar]
  6. Hillemann D, Rüsch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF system. J Clin Microbiol 2011; 49:1202–1205 [View Article][PubMed]
    [Google Scholar]
  7. Vadwai V, Boehme C, Nabeta P, Shetty A, Alland D et al. Xpert MTB/RIF: a new pillar in diagnosis of extrapulmonary tuberculosis?. J Clin Microbiol 2011; 49:2540–2545 [View Article][PubMed]
    [Google Scholar]
  8. Causse M, Ruiz P, Gutiérrez-Aroca JB, Casal M. Comparison of two molecular methods for rapid diagnosis of extrapulmonary tuberculosis. J Clin Microbiol 2011; 49:3065–3067 [View Article][PubMed]
    [Google Scholar]
  9. Moure R, Martín R, Alcaide F. Effectiveness of an integrated real-time PCR method for detection of the Mycobacterium tuberculosis complex in smear-negative extrapulmonary samples in an area of low tuberculosis prevalence. J Clin Microbiol 2012; 50:513–515 [View Article][PubMed]
    [Google Scholar]
  10. World Health Organization Xpert MTB/RIF System for the Diagnosis of Pulmonary and Extra-Pulmonary TB in Adults and Children. Policy Update Geneva, Switzerland: World Health Organization; 2013
    [Google Scholar]
  11. Clinical and Laboratory Standards Institute Laboratory Detection and Identification of Mycobacteria; Approved Guideline Wayne: Clinical and Laboratory Standards Institute; 2008
    [Google Scholar]
  12. World Health Organization Laboratory Services in Tuberculosis Control Geneva, Switzerland: World Health Organization; 1998
    [Google Scholar]
  13. Richter E, Weizenegger M, Rüsch-Gerdes S, Niemann S. Evaluation of genotype MTBC assay for differentiation of clinical Mycobacterium tuberculosis complex isolates. J Clin Microbiol 2003; 41:2672–2675 [View Article][PubMed]
    [Google Scholar]
  14. Cavusoglu C, Hilmioglu S, Guneri S, Bilgic A. Characterization of rpoB mutations in rifampin-resistant clinical isolates of Mycobacterium tuberculosis from Turkey by DNA sequencing and line probe assay. J Clin Microbiol 2002; 40:4435–4438 [View Article][PubMed]
    [Google Scholar]
  15. Mani C, Selvakumar N, Narayanan S, Narayanan PR. Mutations in the rpoB gene of multidrug-resistant Mycobacterium tuberculosis clinical isolates from India. J Clin Microbiol 2001; 39:2987–2990 [View Article][PubMed]
    [Google Scholar]
  16. World Health Organization Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF System Geneva, Switzerland: World Health Organization; 2011
    [Google Scholar]
  17. Tortoli E, Russo C, Piersimoni C, Mazzola E, dal Monte P et al. Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis. Eur Respir J 2012; 40:442–447 [View Article][PubMed]
    [Google Scholar]
  18. Kim CH, Hyun IG, Hwang YI, Kim DG, Lee CY et al. Identification of Mycobacterium tuberculosis and rifampin resistance in clinical specimens using the Xpert MTB/RIF assay. Ann Clin Lab Sci 2015; 45:32–38[PubMed]
    [Google Scholar]
  19. du J, Huang Z, Luo Q, Xiong G, Xu X et al. Rapid diagnosis of pleural tuberculosis by Xpert MTB/RIF assay using pleural biopsy and pleural fluid specimens. J Res Med Sci 2015; 20:26–31[PubMed]
    [Google Scholar]
  20. Maynard-Smith L, Larke N, Peters JA, Lawn SD. Diagnostic accuracy of the Xpert MTB/RIF assay for extrapulmonary and pulmonary tuberculosis when testing non-respiratory samples: a systematic review. BMC Infect Dis 2014; 14:709 [View Article][PubMed]
    [Google Scholar]
  21. Friedrich SO, von Groote-Bidlingmaier F, Diacon AH. Xpert MTB/RIF assay for diagnosis of pleural tuberculosis. J Clin Microbiol 2011; 49:4341–4342 [View Article][PubMed]
    [Google Scholar]
  22. Joloba ML, Johnson JL, Feng PJ, Bozeman L, Goldberg SV et al. What is the most reliable solid culture medium for tuberculosis treatment trials?. Tuberculosis 2014; 94:311–316 [View Article][PubMed]
    [Google Scholar]
  23. Cruciani M, Scarparo C, Malena M, Bosco O, Serpelloni G et al. Meta-analysis of BACTEC MGIT 960 and BACTEC 460 TB, with or without solid media, for detection of mycobacteria. J Clin Microbiol 2004; 42:2321–2325 [View Article][PubMed]
    [Google Scholar]
  24. Helb D, Jones M, Story E, Boehme C, Wallace E et al. Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol 2010; 48:229–237 [View Article][PubMed]
    [Google Scholar]
  25. Zhang HQ, Zhao YL. Modern Diagnostic Techniques for Tuberculosis Beijing, PR China: People`s Medical Publishing House; 2013 p. 49
    [Google Scholar]
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