Comparison of Amplicor and GeneXpert MTB/RIF Tests for Diagnosis of Tuberculous Meningitis

Patel, Vinod; Connolly, Cathy; Singh, Ravesh; Lenders, Laura; Matinyenya, Brian; Theron, Grant; Ndung’u, Thumbi; Dheda, Keertan

doi:10.1128/jcm.01235-14

Cited by 24 publications

(10 citation statements)

References 29 publications

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“…The Automated Xpert MTB/RIF produced a high diagnostic accuracy for pulmonary TB in sputum samples, our finding was in strong agreement with a study done by Vinod et al (2014) [24], although he used samples from Tuberculous meningitis. In our study, one patient sample was positive with Xpert MTP/RIF and negative by culture, the test can detect M. tuberculosis DNA from either nonviable or non-intact bacilli [25], taking into account also the culture limitation.…”

Section: Discussionsupporting

confidence: 82%

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Abdelhaleem¹,

Hershan²,

Agarwal³

2017

JTR

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Purpose: To evaluate diagnostic accuracy of IS6110 insertion genes, hsp65, and Xpert MTB/RIF for rapid diagnosis of pulmonary tuberculosis. Methods: Sixty patients, medically reported HIV negative, clinically suspected of having pulmonary tuberculosis, were included in this study, and consented before enrolment. Sputum samples were gathered once, and tested by smear for Acid Fast Bacilli (AFB). Cultured in the Loewenstein-Jensen (LJ) medium for M. tuberculosis growth, M. tuberculosis DNA was detected by conventional PCR targeting IS6110, and hsp65 genes using specific primers, and automated nested real-time PCR targeting rpoB gene. Sensitivity, specificity and diagnostic accuracy were calculated for each method compared to culture. Results:Compared with culture as reference method, smear, IS6110, hsp65, and Xpert MTB/RIF had sensitivity 77.14%, 100%, 100%, and 100%, specificity 92%, 96%, 96%, and 96.97%, and diagnostic accuracy 83.33%, 98.33%, 98.33% and 98.21% respectively. Molecular diagnostic methods had the highest diagnostic accuracy, whereas smear had the lowest. No statistical significance, (p value > 0.05) was detected between the patients' demographic data and the presence or absence of TB infection. Conclusion: The diagnostic accuracy that we got from the molecular methods, confirmed the diagnostic value of molecular detection of M. tuberculosis in pulmonary cases, supporting the application of automated and conventional PCR in rapid analysis. Smear could be more efficient when used for treatment monitoring. Combination between one-molecular techniques with smear as a routine method could be valid for rapid diagnosis of TB.

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Section: Discussionsupporting

confidence: 82%

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Abdelhaleem¹,

Hershan²,

Agarwal³

2017

JTR

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“…After screening the abstracts, 118 articles were found to fulfil the inclusion criteria and were selected for full‐text review (Figure 1). Thirty articles ( n = 3972) assessing the performance of Xpert MTB/RIF for TBM were included in our systematic review and meta‐analysis [14, 25–53].…”

Section: Resultsmentioning

confidence: 99%

“…There was unclear risk of bias for all studies about index and reference tests, due to the problematic, imperfect reference standard of TBM. Most studies had applicability concerns about the reference standard, with the exception of 9 studies which utilised explicitly the Marais uniform case TBM definition [14, 26, 29, 31, 32, 34, 39, 48, 52].…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta‐analysis

Hernandez

Laurentis

Souza

et al. 2020

Tropical Med Int Health

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Objective This systematic review evaluated the diagnostic accuracy of Xpert MTB/RIF to detect tuberculous meningitis (TBM). Methods PubMed and five other databases were systematically searched through March 2019. All studies evaluating diagnostic accuracy of Xpert MTB/RIF on cerebrospinal fluid (CSF) samples were included. Reference standards were definitive or definite plus probable TBM. The quality of studies was assessed by the QUADAS‐2 tool. We performed bivariate random‐effects meta‐analysis and calculated summary diagnostic statistics. Results We identified 30 studies (n = 3972 participants), including 5 cohort studies and 25 cross‐sectional studies. Reference standards were definite TB (n = 28 studies) or definite plus probable TBM (n = 6 studies). The pooled Xpert MTB/RIF sensitivity was 85% (95% CI, 70–93%), and specificity was 98% (95% CI, 97–99%) with a negative likelihood ratio of 0.15 (95% CI, 0.04–0.27) for definite TBM. For probable TBM cases, pooled sensitivity was 81% (95% CI, 66–90%), and specificity was 99% (95% CI, 97–99%). For both reference standard types, meta‐analyses showed a C‐statistic area under the curve of 0.98. The QUADAS‐2 tool revealed low risk of bias as well as low concerns regarding applicability. Methodological heterogeneity was high among studies. Conclusions Xpert MTB/RIF showed high accuracy for TBM diagnosis, but a negative Xpert MTB/RIF test does not rule out TBM. Repeat Xpert testing may be necessary. In clinical practice, Xpert MTB/RIF adds speed and sensitivity when compared to classic TBM diagnostic methods or previous commercial nucleic acid amplification techniques. More studies and better strategies for rapidly confirming a diagnosis of TBM in children are urgently needed.

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“…Another automated technique based on real-time PCR is Xpert MTB/RIF, which also has a sensitivity of 48%, but was negative in all four patients tested in HIVuninfected cases. Furthermore, it is poorly sensitive in suspected cases [24,25]. The IFN gamma release assay (IGRA) is another technique that has been extensively used in the diagnosis of TB; for TBM, however, it is moderately sensitive according to meta-analysis and the authors also concluded that CSF PCR or ADA have better diagnostic accuracy than IGRAs in TBM [26].…”

Section: Discussionmentioning

confidence: 99%

IgG response to Mycobacterium tuberculosis non-polar lipids and sonicated extracts among tuberculous meningitis patients

Giribhattanavar

Pirson

Kumar

et al. 2020

Access Microbiology

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Introduction. The diagnosis of tuberculous meningitis (TBM) is a major global health concern due to its protean nature. There is a need to identify better biomarkers for the rapid and definitive diagnosis of TBM. Lipids have been poorly explored as diagnostic markers in TBM. Aim. Non-polar lipids (NPL) and mycobacterial sonicate extract (MTSE) antigens were assessed for diagnosis of Mycobacterium tuberculosis . Methodology. A total of 110 cerebrospinal fluid samples were categorized as confirmed, suspected and non-TBM cases according to clinical presentation and laboratory investigations, which were further analysed by NPL and MTSE ELISA. Results. The sensitivity and specificity of the NPL ELISA were 39.6 and 96 %, respectively, whereas the MTSE ELISA was 17 % sensitive and 92 % specific. The combination of the NPL and MTSE ELISA test was superior to these tests alone, with sensitivity and specificity of 43 and 88 %, respectively. Conclusion. This combination may be useful as an adjunct in the laboratory diagnosis of TBM. However, future studies in different settings among different populations, such as those with human immunodeficiency virus co-infection, are desirable to explore the full potential of biomarkers.

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Comparison of Amplicor and GeneXpert MTB/RIF Tests for Diagnosis of Tuberculous Meningitis

Cited by 24 publications

References 29 publications

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta‐analysis

IgG response to Mycobacterium tuberculosis non-polar lipids and sonicated extracts among tuberculous meningitis patients

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Comparison of Amplicor and GeneXpert MTB/RIF Tests for Diagnosis of Tuberculous Meningitis

Cited by 24 publications

References 29 publications

Diagnostic Accuracy of IS6110 Insertion Gene, &lt;i&gt;Hsp65&lt;/i&gt;, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Diagnostic Accuracy of IS6110 Insertion Gene, &lt;i&gt;Hsp65&lt;/i&gt;, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta‐analysis

IgG response to Mycobacterium tuberculosis non-polar lipids and sonicated extracts among tuberculous meningitis patients

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Product

Resources

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Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis

Diagnostic Accuracy of IS6110 Insertion Gene, <i>Hsp65</i>, and Xpert MTB/RIF for Rapid Diagnosis of Pulmonary Tuberculosis