Accuracy of the Xpert&lt;SUP&gt;®&lt;/SUP&gt; MTB/RIF assay for the diagnosis of extra-pulmonary tuberculosis in South Korea

Yw, Kim; Kwak, Nakwon; Seong, Moon Woo; Ec, Kim; Yoo, Christopher H.; Han, Shiyu; Yim, Jae Joon

doi:10.5588/ijtld.14.0500

Cited by 29 publications

(34 citation statements)

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“…Data on Xpert performance in CSF in adults are limited to reports of small numbers of meningitis patients in extra-pulmonary TB cohorts 10–18 , multiple meta-analyses 9,19,20 , and two well-conducted TBM cohort studies. 21,22 In South Africa, Patel et al found 67% sensitivity with Xpert in microbiologically proven TBM.…”

Section: Introductionmentioning

confidence: 99%

Improved diagnostic sensitivity for tuberculous meningitis with Xpert<SUP>®</SUP> MTB/RIF of centrifuged CSF

Bahr¹,

Tugume

Rajasingham

et al. 2015

int j tuberc lung dis

110

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Introduction TB meningitis (TBM) diagnosis is difficult and novel diagnostic methods are needed. The World Health Organization recommends Xpert MTB/RIF (Xpert) as the initial TBM diagnostic test, based on two studies reporting suboptimal sensitivity (~50–60%). Objective To study the effect of cerebrospinal fluid (CSF) centrifugation on Xpert performance for TBM detection. Design 107 predominantly HIV-infected adults with suspected meningitis were screened prospectively in Kampala, Uganda. CSF was tested by 1) microscopy for acid-fast bacilli; 2) Mycobacteria growth indicator tube culture; 3) Xpert of 2mL of unprocessed CSF; 4) Xpert of centrifuged CSF. Diagnostic performance was measured against an a priori composite reference standard of any positive CSF tuberculosis test. Results 17% (18/107) of participants had definite TBM. When CSF was centrifuged, Xpert had better sensitivity (72%, 13/18) than when using 2mL of unprocessed CSF (28%, 5/18; P=0.008). The median centrifuged CSF volume was 6mL (IQR 4–10mL). Mycobacterial culture yielded 71% (12/17) sensitivity at a median delay of 27 days. Only 39% were positive both by culture and centrifuged Xpert, with additional cases detected by Xpert and culture. Conclusions Centrifuging of CSF optimizes Xpert diagnostic performance for detection of TBM. A combination of culture and Xpert detected the largest number of cases.

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Section: Introductionmentioning

confidence: 99%

Improved diagnostic sensitivity for tuberculous meningitis with Xpert<SUP>®</SUP> MTB/RIF of centrifuged CSF

Bahr¹,

Tugume

Rajasingham

et al. 2015

int j tuberc lung dis

110

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“…The studies also used different culture references. Nine studies only used BACTEC MGIT 960 liquid culture as the reference, one study only used Lowenstein-Jensen solid culture as the reference [34], and four studies used both of them as references [18,22,24,35]. The performances of BACTEC MGIT 960 liquid and Lowenstein-Jensen solid cultures were different [54], which might also be one of the sources of heterogeneity among the studies.…”

Section: Discussionmentioning

confidence: 99%

“…The kappa index of agreement for the selection and data extraction was 0.877 (95% CI, 0.779-0.975) between the two investigators. Only two studies were conducted in high-income countries [18,35], while the rest were conducted in low-and middle-income countries. Fifteen articles were written in English and eleven in Chinese.…”

Section: Identification Of Studies and Study Characteristicsmentioning

confidence: 99%

“…The pooled sensitivity of Xpert MTB/RIF was 96% (I 2 = 91%; 95% CI, 90-98). The specificity of Xpert MTB/RIF ranged from 17% (95% CI, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] to 100% (95% CI, 99-100) and the pooled specificity was 85% (I 2 = 97%; 95% CI, 57-96) ( Fig 4). As expected, the sensitivity was improved, and the specificity was undervalued when compared to the culture.…”

Section: Diagnostic Accuracy Of Xpert Mtb/rif Assay For Bjtbmentioning

confidence: 99%

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Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Shen¹,

Yu²,

Zhong³

et al. 2019

PLoS ONE

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BackgroundThis study aimed to evaluate the accuracy of the Xpert MTB/RIF assay for the diagnosis of bone and joint tuberculosis. MethodsWe searched databases from their inception to May 7, 2019 for published articles and reviewed them to assess the accuracy of Xpert MTB/RIF with respect to a composite reference standard (CRS) and mycobacterial culture. Meta-analyses were performed using a bivariate random-effects model, and the sources of heterogeneity were assessed via subgroup analysis and meta-regression. ResultsNineteen independent (9 prospective, 5 retrospective, and 5 case-control) studies that compared Xpert MTB/RIF with the CRS and 14 (6 prospective, 7 retrospective, and 1 case-control) studies that compared it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 81% (95% confidence interval [CI], 77-84) and 99% (95% CI, 97-100) compared to the CRS, respectively, and 96% (95% CI, 90-98) and 85% (95% CI, 57-96) compared to culture, respectively. The pooled sensitivity and specificity using pus samples vs. the CRS were 82% (95% CI, 76-86) and 99% (95% CI, 95-100), respectively. The proportions obtained while working with tissue samples vs. the CRS were 84% (95% CI, 76-90) and 98% (95% CI, 94-99), respectively. There was no significant difference in diagnostic accuracy among the types of specimens. ConclusionsXpert MTB/RIF demonstrates good diagnostic accuracy for bone and joint tuberculosis, the results of which are not related to the type of specimen.

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“…In patients with suspected tuberculosis, the final diagnosis was identified by the retrospective medical record review and classified into tuberculosis and non-tuberculosis. The final diagnosis of tuberculosis was made based on radiological and clinical improvement after 6 months of standard anti-tuberculosis therapy [10,13]. The standard therapy was defined according to guidelines as an intensive phase, consisting of isoniazid, rifampin, ethambutol, and pyrazinamide, followed by a continuation phase, consisting of isoniazid, rifampin, and ethambutol.…”

Section: Definition Of Tuberculosis and Non-tuberculosismentioning

confidence: 99%

Changes in chest X-ray findings in 1- and 2-month group after treatment initiation for suspected pulmonary tuberculosis

Lee

Kim

et al. 2020

Korean J Intern Med

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Background/Aims Although re-evaluation of radiographic follow-up after 2 to 3 months of therapy is recommended for patients administered anti-tuberculosis medication owing to suspected pulmonary tuberculosis, reported findings are limited. Therefore, this study aimed to investigate changes in 1- and 2-month chest X-ray (CXR) findings after the treatment initiation and compared them according to the final diagnosis of tuberculosis or non-tuberculosis. Methods Patients who started anti-tuberculosis medication for suspected pulmonary tuberculosis were selected at a tertiary referral hospital in South Korea between January 2012 and December 2015. Changes in the 1- and 2-month CXR findings were classified as improved, unchanged, and aggravated. Results Among the 120 patients enrolled in the 1-month CXR group, 76 (63.3%) had the final diagnosis of tuberculosis. Comparison between the 1-month CXR changes and diagnosis showed that the final diagnosis was tuberculosis in 81.8% (45/55), 50.0% (26/52), and 38.5% (5/13) of patients whose 1-month CXR was improved, unchanged, and aggravated, respectively. In the 2-month CXR group, 167 patients were enrolled, and 139 (83.2%) of them were diagnosed with tuberculosis. Tuberculosis was the final diagnosis in 92.6% (100/108), 70.0% (35/50), and 44.4% (4/9) patients with improved, unchanged, and aggravated 2-month CXR findings, respectively. In patients with the final diagnosis of non-tuberculosis, nontuberculous mycobacteria and malignancy were the most common causes of improved and aggravated 1- and 2-month CXR findings, respectively. Conclusions Two-month CXR findings were of limited value for deciding on whether to continue anti-tuberculosis treatment. One-month CXR findings could help determine the need for further work-up.

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Accuracy of the Xpert<SUP>®</SUP> MTB/RIF assay for the diagnosis of extra-pulmonary tuberculosis in South Korea

Abstract: The Xpert assay showed acceptable sensitivity in certain groups and excellent specificity in diagnosing EPTB and detecting RMP resistance in an intermediate TB burden country.

Cited by 29 publications

References 1 publication

Improved diagnostic sensitivity for tuberculous meningitis with Xpert<SUP>®</SUP> MTB/RIF of centrifuged CSF

Improved diagnostic sensitivity for tuberculous meningitis with Xpert<SUP>®</SUP> MTB/RIF of centrifuged CSF

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Changes in chest X-ray findings in 1- and 2-month group after treatment initiation for suspected pulmonary tuberculosis

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