Assessment of Extrapulmonary Tuberculosis Using Gene Xpert MTB/RIF Assay and Fluorescent Microscopy and Its Risk Factors at Dessie Referral Hospital, Northeast Ethiopia

Abstract

Background Tuberculosis is a major public health problem and extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. Objective To determine the magnitude of EPTB, associated risk factors, and agreement of diagnostic techniques at Dessie Referral Hospital. Methods A cross-sectional study was conducted on consecutive presumptive EPTB cases from March 1 to June 30, 2017. Sociodemographic characteristics and other variables were collected using a structured questionnaire. Clinical specimens were collected and processed using fluorescent microscopy and Gene Xpert assay. Data was analyzed using SPSS version 20. Chi-square test and logistic regression were done and a P value of ≤0.05 was taken as statistically significant. Results From a total of 353 presumptive EPTB cases the overall prevalence of Gene Xpert assay and smear confirmed patients was 8.8% and 2.5%, respectively. Tuberculosis lymphadenitis was the predominant (33.3%) type followed by pleural (11.9%) and peritoneal (6.7%) tuberculosis. Previous history of pulmonary tuberculosis was significantly associated with extrapulmonary infection (AOR:2.8; 95%CI: 1.05-7.54; p=0.04); however, other variables such as age, residence, sex, marital status, occupation, level of education, and monthly income did not show any association. Conclusion High proportions (71%) of Gene Xpert assay confirmed EPTB patients were smear-negative. Sensitivity of microscopy should be enhanced in resource limited countries like Ethiopia where Gene Xpert machine is not easily accessible.

Does Xpert MTB/RIF Assay Give Rifampicin Resistance Results Without Identified Mutation? Review of Cases from Addis Ababa, Ethiopia.

“…Among 100 RR-TB results, majority (62%) were detected from sputum samples, while the remaining 38 samples were detected from deferent types of extra pulmonary samples. Among the extra pulmonary samples, half were a lymph node aspirate sample which is similar with the study reported from Dessie, Ethiopia (11). In this review higher DNA amount (high or medium) was observed in the sputum samples, while lower DNA amount (low or very low) was observed in extra pulmonary samples.…”

Does Xpert® MTB/RIF assay give rifampicin resistance results without identified mutation? Review of cases from Addis Ababa, Ethiopia

“…Among 100 RR-TB results, the majority (62) was detected from sputum samples, while the remaining 38 samples were detected from different types of extrapulmonary samples. From the extrapulmonary samples, half was a lymph node aspirate sample which is similar to the study reported from Dessie, Ethiopia [14]. In this review higher DNA amount (high or medium) was observed in the sputum samples, while lower DNA amount (low or very low) was observed in extrapulmonary samples.…”

Epidemiology and the diagnostic challenge of extra-pulmonary tuberculosis in a teaching hospital in Ethiopia

“…The national TB programs, however, have focused on PTB because of transmissibility, and likewise, the majority of studies done in Ethiopia focused on PTB [9]. Some of the previously conducted studies in Ethiopia focused on the genotypic characterization of mycobacterium causing EPTB [8,[10][11][12] and other assessed diagnostic modalities accuracy and sensitivity for lymph nodes TB [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. A detailed characterization incorporating sociodemographic, clinical, laboratory, and radiological features of adult EPTB cases is lacking in Ethiopia.…”