Clinical validation of urine-based Xpert® MTB/RIF assay for the diagnosis of urogenital tuberculosis: A systematic review and meta-analysis

Abstract

Objectives: Effective methods for diagnosing urogenital tuberculosis (UGTB) are important for its clinical management. Therefore, we undertook a systematic review to assess the performance of the urine-based Xpert MTB/RIF assay for UGTB. Methods: PubMed, Embase, Web of Science, the Cochrane library, and Scopus were systematically searched up to July 30, 2019. A hierarchical summary receiver operating characteristic (HSROC) was applied to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and odds ratio (OR) for the diagnostic accuracy of the Xpert test. Results: Our search identified 858 unique articles from which 69 studies were selected for full-text revision, with 12 studies meeting the inclusion criteria. Eleven studies comprising 1202 samples compared Xpert with mycobacterial culture, while 924 samples from eight studies compared it with a composite reference standard (CRS). The values for pooled sensitivity, specificity, PLR, NLR, and OR were 0.89, 0.95, 20.1, 0.18, and 159.53, respectively, when compared with the mycobacterial culture. Likewise, when compared with a CRS, the respective pooled sensitivity, specificity, PLR, NLR, and OR values were 0.55, 0.99, 40.67, 0.43, and 166.17, thereby suggesting a high level of accuracy for diagnosing UGTB. A meta-regression and sub-group analysis of TB-burden countries, study design, decontamination, concentration, and reference standard could not explain the heterogeneity (p > 0.05) in the diagnostic efficiency. Conclusions: Our results suggested that Xpert is a promising diagnostic tool for the diagnosis of UGTB via urine specimen.

Application of acid-fast staining combined with GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease

“…Moreover, GeneXpert MTB/RIF is easy to operate, and the results can be obtained within 2 h after approximately 2 min of setting up the experiment using manual steps (Lee et al, 2019;Steingart et al, 2014). In addition to lung specimens, the ability of GeneXpert MTB/RIF to detect M. tuberculosis in gastric fluid (Tan et al, 2020;van Brusselen et al, 2020), urine (Chen et al, 2020), cerebrospinal fluid (Patel et al, 2020), and biopsy tissue samples (Solanki et al, 2019) has also been verified in previous reports. It was also reported in a previous study that the sensitivity of a single GeneXpert MTB/RIF experiment to diagnose tuberculosis was 88.9% (95% CI 57-99%), which was higher than that of three acid-fast staining experiments (66.7%; 95% CI 35-88%) (Yeong et al, 2020).…”

TEMPORARY REMOVAL: Adverse pregnancy outcomes after in vitro fertilization due to undiagnosed urogenital tuberculosis and proposed screening algorithm for patients from tuberculosis-endemic countries

“…If the patient’s history, exam, and imaging are particularly compelling, patients should undergo further testing (such as biopsy for AFB stain, culture, and pathology) even if tests for TB exposure (i.e., IGRA, TST) are negative. If possible, we suggest noninvasive testing, such as urine AFB PCR ( 18 ) and culture, be sent before surgical biopsy ( Figure 4 ). Of note, testing the urine is helpful if positive, but it is possible to have isolated genital TB with no urinary involvement.…”

Tuberculose extrapulmonar com envolvimento renal e intestinal: Um desafio no diagnóstico precoce

“…É importante destacar que o dano causado por essas lesões pode ser irreversível. Contudo, instituição do tratamento precoce com medicamentos antituberculosos podem minimizar agressões da micobacteria frente ao hospedeiro (WHO, 2021;Chen, et al, 2020;Krishnamoorthy, et al, 2017;Ramachandran, et al, 2021;Rotilli & Valenzuela, 2022).…”