Evaluation of line-probe assay for molecular analysis and drug susceptibility of extra-pulmonary tuberculosis

Raghuvanshi, Shailendra; Kotwal, Aarti; Maheshwari, Raaz; Sindhwani, Girish

doi:10.5588/ijtld.17.0802

Cited by 7 publications

(4 citation statements)

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“…Although NTM has been reported as an important pathogen in PTB samples, musculoskeletal infections with NTM are rarely reported, but our laboratory is sensitized to NTM diagnosis in EPTB samples, and a similar finding has been reported in EPTB samples in one of our previous studies, too [ 4 , 14 , 15 ]. Thus, it is imperative that the possibility of NTM in MSTB samples needs to be explored and all possible measures taken to identify this pathogen at all laboratories.…”

Section: Discussionsupporting

confidence: 81%

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Multidrug-Resistant Musculoskeletal Tuberculosis: An Aggressive Clinical, Radiological and Molecular Confirmation With Genotypic Drug Susceptibility Testing Approach

Sethi¹,

Raghuvanshi²,

Kotwal³

et al. 2022

Cureus

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Increasing evidence suggests that musculoskeletal tuberculosis (MSTB) causes significant morbidity due to the late presentation of symptoms and lack of accurate diagnosis. We aimed to assess the utility of two modalities, viz. radiology and molecular methods, in the early diagnosis of MSTB. Also, the rate of resistance to two basic first-line antitubercular drugs in musculoskeletal TB cases among clinically suspected patients was analyzed. MethodsSamples from 119 patients with clinical suspicion of musculoskeletal TB were included. A radiological workup of patient and smear microscopy, mycobacterial culture, real-time multiplex polymerase chain reaction (PCR), cartridge based nucleic acid amplification test (CBNAAT), and line probe assay (LPA) of samples were carried out. ResultsMaximum positivity (69.74%) was observed by real-time multiplex, followed by CBNAAT and LPA (68.9%), mycobacterial culture (40.3%), and smear microscopy (19.3%). One additional advantage of using multiplex PCR was the detection of non-tuberculous mycobacteria (NTM) isolate. Forty-five strains (54.9%) on LPA were susceptible to rifampicin and isoniazid, eight (9.8%) were rifampicin mono-resistant, seven (8.5%) were isoniazid (INH) mono-resistant, and 22 (26.8%) were multidrug resistant. ConclusionsMSTB diagnosis can be expedited by the combination of radiology and molecular methods. The positivity rate escalates, turnaround time improves, and the additional advantage of detection of drug resistance is added when this algorithm is included for clinching the diagnosis of MSTB.

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Section: Discussionsupporting

confidence: 81%

“…India, with a large pool of mono-resistant along with rising multidrug-resistant TB (MDR-TB) patients, needs an active approach to tackle the problem. In 2015, India reported 20,763 patients with MDR-TB [ 4 ]. The rise was exponential in 2016 with 3.9% of new and 21% of previously treated cases being MDR.…”

Section: Introductionmentioning

confidence: 99%

Multidrug-Resistant Musculoskeletal Tuberculosis: An Aggressive Clinical, Radiological and Molecular Confirmation With Genotypic Drug Susceptibility Testing Approach

Sethi¹,

Raghuvanshi²,

Kotwal³

et al. 2022

Cureus

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“…Previous research has indicated that the incidence and prevalence of extrapulmonary tuberculosis may be underestimated due to several factors, including inadequate attention to extrapulmonary tuberculosis, insufficient diagnostic methods, and low rates of confirmation. This situation has led to a consistently lower cure rate for EPTB compared to PTB, posing challenges to global tuberculosis control efforts (Gambhir et al, 2017;Raghuvanshi et al, 2018). In this study, the detection rates of Gene Xpert, TB-DNA, and sputum culture for extrapulmonary tuberculosis are as follows: 11.76%, 16.67%, and 25%.…”

Section: Discussionmentioning

confidence: 80%

Diagnostic value of chemiluminescence for urinary lipoarabinomannan antigen assay in active tuberculosis: insights from a retrospective study

Huang,

Niu,

Zhang

et al. 2023

Front. Cell. Infect. Microbiol.

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PurposeThis study aimed to assess the efficacy of chemiluminescence-based urinary lipoarabinomannan (LAM) antigen assay as a diagnostic tool for identifying active tuberculosis.MethodsA retrospective study was conducted on 166 Tuberculosis (TB), 22 Non-Tuberculous Mycobacteria (NTM), 69 Non-TB cases, and 73 healthy controls from Zhangjiagang First Peoples Hospital between July 2022 and November 2022. Clinical and laboratory data were collected, including urine samples for LAM antigen detection, sputum samples and pleural effusion for GeneXpert, TB-DNA, and culture.ResultsTB group exhibited a higher LAM positivity rate (P < 0.001). CD4 count and diabetes as independent factors influencing the diagnostic accuracy of LAM. The LAM assay showed a sensitivity of 50.6% and a specificity of 95.65%. Notably, LAM’s sensitivity was superior to TB-DNA (50.60% vs. 38.16%, P < 0.05). LAM’s PTB detection rate was 51.7%, superior to TB-DNA (P = 0.047). Moreover, in EPTB cases, the LAM detection rate was 42.11%, surpassing Gene Xpert (P = 0.042), as well as exceeding the detection rates of TB-DNA and sputum culture.ConclusionLAM antigen detection using chemiluminescence has demonstrated outstanding clinical diagnostic value for active TB, especially in the diagnosis of extrapulmonary TB. The convenience of sample collection in this diagnostic approach allows for widespread application in the clinical diagnosis of active tuberculosis, particularly in cases of EPTB and sputum-negative patients.

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“…In contrast to these molecular methods, the conventional AFB microscopy showed the lowest-yielding performance for the detection of EPTB cases with a sensitivity of 27.0% and 25.3% against culture and CRS, respectively, whereas the specificity was 99.1% and 100%, respectively. This poor sensitivity of AFB microscopy, however, is not surprising, as former studies have already described the lower sensitivity of this model [28,29]. The specificity of AFB microscopy (99.1%) is higher in terms of culture compared to the Xpert MTB/RIF (96%) and MTBDRplus assay (96.5%).…”

Section: Discussionmentioning

confidence: 58%

Diagnostic Performance of Different Laboratory Methods for the Detection of Extrapulmonary Tuberculosis

et al. 2023

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Accurate and appropriate extrapulmonary tuberculosis (EPTB) diagnosis remains challenging due to its paucibacillary nature, requirement of invasive collection procedures, and lack of sensitive tests. This study investigated the diagnostic performance of different methods for the diagnosis of EPTB. A total of 1340 EPTB specimens were collected from presumptive EPTB patients from four different hospitals between November 2015 and March 2017. The collected specimens were tested with AFB microscopy, culture, Xpert MTB/RIF assay (Xpert), and MTBDRplus assay. Among the 1340 EPTB specimens, 49 (3.66%), 141 (10.52%), 166 (12.39%), and 154 (11.49%) were positive in AFB microscopy, culture, Xpert MTB/RIF, and MTBDRplus assay, respectively. A total of 194 (14.9%) cases were found positive in at least one of these methods. Using culture as a reference standard, the sensitivity and specificity of AFB microscopy, Xpert MTB/RIF, and MTBDRplus assay were: 27.0%/99.1%, 83.7%/96.0%, and 79.4%/96.5%, respectively. Compared to the composite reference standard, the sensitivity of culture, AFB microscopy, Xpert MTB/RIF, and MTBDRplus assay was 72.7%, 25.3%, 85.6%, and 79.4%, respectively, with a specificity of 100% for all the methods. The Xpert MTB/RIF assay showed the highest sensitivity compared to other methods. Considering the short turnaround time and promising findings, Xpert MTB/RIF assay should be integrated into national TB guidelines as a routine diagnostic test.

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Evaluation of line-probe assay for molecular analysis and drug susceptibility of extra-pulmonary tuberculosis

Abstract: Given the paucibacillary nature of EPTB, we demonstrated that PCR and LPA can have a vital role in establishing TB diagnosis in extra-pulmonary tissues.

Cited by 7 publications

References 0 publications

Multidrug-Resistant Musculoskeletal Tuberculosis: An Aggressive Clinical, Radiological and Molecular Confirmation With Genotypic Drug Susceptibility Testing Approach

Multidrug-Resistant Musculoskeletal Tuberculosis: An Aggressive Clinical, Radiological and Molecular Confirmation With Genotypic Drug Susceptibility Testing Approach

Diagnostic value of chemiluminescence for urinary lipoarabinomannan antigen assay in active tuberculosis: insights from a retrospective study

Diagnostic Performance of Different Laboratory Methods for the Detection of Extrapulmonary Tuberculosis

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