Multicentre evaluation of Xpert MTB/RIF assay in detecting urinary tract tuberculosis with urine samples

Abstract

Genitourinary tuberculosis (GUTB) accounts for up to 40% of extrapulmonary tuberculosis cases. Rapid tests for GUTB are urgently needed because it is often associated with delayed health-care seeking, leading to serious consequences. This study evaluated the performance of the Xpert MTB/RIF assay in the rapid diagnosis of urinary tract tuberculosis (UTB) and rifampicin-resistant tuberculosis with urine specimens. In all, 302 patients were included from four hospitals in China. Suspected UTB patients were tested with Xpert, smear, and MGIT 960 culture. Drug susceptibility testing (DST) was conducted for culture-positive cases. The performance of the assays was evaluated against MGIT 960 culture and a composite reference standard (CRS). Among all participants, 150 (49.7%) had CRS-positive UTB, of whom 36 (24.0%) were culture-confirmed. Against culture, Xpert and smear achieved a sensitivity of 94.4% (95% CI: 81.3–99.3%) and 22.2% (95% CI: 10.1–39.2%), respectively. Against CRS, the sensitivity of Xpert, smear and culture was 41.3% (95% CI: 33.4–49.7%), 7.3% (95% CI: 3.7–12.7%), and 24.0% (95% CI: 17.4–31.6%). Xpert had better performance than smear and culture in detecting UTB from urine samples and could be considered for the diagnosis of UTB. Moreover, Xpert showed better performance than MGIT 960-based DST using urine culture.

Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy

“…Studies have shown that pleural biopsies, obtained under medical thoracoscopy guidance, are better specimens than the pleural fluid for diagnosing tuberculous pleuritis [9,14,15]. Our group has previously evaluated the performance of Xpert using urine specimens for the rapid diagnosis of urinary tract TB, and the data indicated a better performance of Xpert than that of smear and culture identification, thus suggesting that Xpert could be considered for the diagnosis of urinary tract TB [16].…”

Enfermedades musculoesqueléticas y su asociación con el sobrepeso y obesidad en adultos mayores, un estudio transversal

“…En torno a los datos de este estudio se observa una mayor frecuencia de lumbalgia, lumbalgia de esfuerzo y gonartrosis en ambos sexos asociada al sobrepeso y obesidad. Estudios en poblaciones cercanas muestran prevalencias similares, donde las mujeres con un alto porcentaje de grasa corporal tienen mayor probabilidad de padecer dolor lumbar severo contrastando con hombres con porcentaje de grasa menor que tienen menos riesgo 9 y hasta es considerado un factor de riesgo laboral 10 . también se confirma que el factor de riesgo que más se relacionó a problemas articulares de rodilla fue un aumento del índice de masa corporal 8 ; en Perú, la lumbalgia y sexo femenino fueron asociados en la aparición y progresión de la gonartrosis 11 .…”

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

“…The number of samples evaluated in each study ranged from 21 to 302, with a median value of 96. Overall, eight (67%) studies were carried out in high-burden TB countries, where the TB prevalence was 63-267 per 100 000 population (Chen et al, 2019;Jing et al, 2017;Khan et al, 2018;Kim et al, 2015;Li et al, 2017;Pang et al, 2017;Samuel et al, 2018;Sharma et al, 2014). Four (33%) studies were conducted in low-burden TB countries, where the TB incidence was 0.81-7.5 per 100 000 population (Habous et al, 2019;Hillemann et al, 2011;Mazzola et al, 2016;Tortoli et al, 2012).…”