Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay - Report from a third world country

Iram, Shazia; Zeenat, Asyia; Hussain, Shahid; Yusuf, Noshin Wasim; Aslam, Muhammad

doi:10.12669/pjms.311.6970

Cited by 41 publications

(23 citation statements)

References 14 publications

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“…[ 7 ] However, diagnosis with the bacterial culture still remains the gold standard in many developing countries and the 125-year-old sputum microscopic examination is still the most widely used method for the detection of TB. [ 6 12 ] On the other hand, a single Xpert MTB/RIF run can provide both detection of TB and detection of rifampicin resistance within 2 h.[ 6 ] It is a quick assay with minimum hands-on time and negligible safety concerns for persons handling the samples. WHO recommends the use of Xpert MTB/RIF assay worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…Other available tests include the direct examination of sputum smears with Ziehl–Neelsen (ZN) staining for acid-fast Bacilli , mycobacterial culture sensitivity, and other NAATs and immunological tests. [ 11 12 ] Microscopic examination is suitable for laboratories at peripheral and higher levels and it can be done safely under minimal biosafety conditions. [ 11 ] Mycobacterial culture is taken as the reference standard test for the diagnosis of TB, but this process is cumbersome and time-consuming.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of xpert test in tuberculosis detection: A systematic review and meta-analysis

Kaur¹,

Kachroo

Sharma

et al. 2016

J Global Infect Dis

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Background:World Health Organization (WHO) recommends the use of Xpert MTB/RIF assay for rapid diagnosis of tuberculosis (TB) and detection of rifampicin resistance. This systematic review was done to know about the diagnostic accuracy and cost-effectiveness of the Xpert MTB/RIF assay.Methods:A systematic literature search was conducted in following databases: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, PUBMED, Scopus, Science Direct and Google Scholar for relevant studies for studies published between 2010 and December 2014. Studies given in the systematic reviews were accessed separately and used for analysis. Selection of studies, data extraction and assessment of quality of included studies was performed independently by two reviewers. Studies evaluating the diagnostic accuracy of Xpert MTB/RIF assay among adult or predominantly adult patients (≥14 years), presumed to have pulmonary TB with or without HIV infection were included in the review. Also, studies that had assessed the diagnostic accuracy of Xpert MTB/RIF assay using sputum and other respiratory specimens were included.Results:The included studies had a low risk of any form of bias, showing that findings are of high scientific validity and credibility. Quantitative analysis of 37 included studies shows that Xpert MTB/RIF is an accurate diagnostic test for TB and detection of rifampicin resistance.Conclusion:Xpert MTB/RIF assay is a robust, sensitive and specific test for accurate diagnosis of tuberculosis as compared to conventional tests like culture and microscopic examination.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of xpert test in tuberculosis detection: A systematic review and meta-analysis

Kaur¹,

Kachroo

Sharma

et al. 2016

J Global Infect Dis

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“…Every specimen was processed according to the following methods: 1) ZN smears microscopy according to WHO, 2 2) GeneXpert MTB/RIF assay was performed directly according to the manufacturer’s instructions, 3 and LJ cultures were processed and reported according to standard guidelines. 4…”

Section: Methodsmentioning

confidence: 99%

“…Pulmonary tuberculosis is the most common form, involving lungs while EPTB involves lymph nodes, bone, and joints, kidneys, intestine, abdominal and serous membranes such as pleural, pericardial, and meninges. 2 …”

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confidence: 99%

GeneXpert technology

Saeed

Ahmad

Iram

et al. 2017

SMJ

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Objectives:To evaluate the diagnostic validity of GeneXpert for the detection of Mycobacterium tuberculosis (MTB) in pericardial and pleural effusions samples.Methods:A cross sectional study was conducted at the Mycobacteriology Laboratory, Allama Iqbal Medical College, Lahore, Pakistan. A total of 286 (158 pleural and 128 pericardial fluids) samples were received from tuberculosis (TB) suspects between January 2014 and August 2016. Every sample was processed for Ziehl-Neelsen (Zn) smear, Lowenstein Jensen (LJ) culture, GeneXpert MTB/RIF assay according to standard protocols. Validity of GeneXpert assay for the detection of MTB was evaluated using LJ culture as gold standard.Results:Out of 286 effusions samples, MTB was isolated by LJ culture in 51 (17.8%) samples followed by GeneXpert in 43 (15%), and acid- fast bacilli (AFB) was detected by Zn smear microscopy in 11 (3.8%) samples. GeneXpert showed high sensitivity (84.3%), specificity (100%), with positive predictive value (100%), and negative predictive value (96.7%), while Zn smear showed sensitivity 18.3%, specificity 99.1%, positive predictive value 81.8%, and negative predictive value 85.4%. A strikingly high sensitivity of 72.2% was observed for pericardial fluid by GeneXpert.Conclusion:GeneXpert assay is an innovative tool, for prompt detection of MTB and drug resistance. It is definitely an attractive point of care test, with high sensitivity and specificity along with turn around time of 2 hours, which facilitates timely diagnosis and appropriate management of TB pleuritis and pericarditis.

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“…The specificity of ZN-stained direct sputum smear microscopy (95.28%) was relatively higher compared to the study conducted in Pakistan showing specificity (91.4%) [13,18].The difference might be attributed to sample size and type. In the present study, 244 samples were analyzed, of whom all were sputum while in the study of Pakistan, 387 sputum and 7 bronchial wash were analyzed [13,18,20].…”

Section: Discussionmentioning

confidence: 59%

Diagnostic Performance of Xpert MTB/RIF Assay Versus Ziehl-Neelsen Method for the Diagnosis of Pulmonary Tuberculosis in Addis Ababa, Ethiopia

Taddese¹,

Desalegn²,

Misganaw³

et al. 2018

TOMICROJ

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Background: Worldwide Tuberculosis (TB) is the ninth leading cause of death from a single infectious agent, positioning on top of Human Immuno Deficiency Virus (HIV) and it is still an eminently serious public health problem. In developing countries, Ziehl-Neelsen (ZN)-stained sputum smear microscopy is the most widely used diagnostic method in diagnosing Pulmonary Tuberculosis (PTB). This study was aimed to compare the diagnostic performances of ZN-method with Xpert MTB/RIF assay for the diagnosis of PTB in Addis Ababa, Ethiopia. Methods: Facility-based cross-sectional study design was conducted from September 2016 to June 2017 on a total of 244 sputum samples collected from presumptive TB patients. The L-J sputum culture was used as a gold standard to compare the diagnostic performances of Xpert MTB/RIF assay and ZN-methods. Kappa values were analyzed by using statistical package for Social Science (SPSS) version 20 software at 95% Confidence Interval (CI). The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of ZN-stained sputum smear microscopy and Xpert MTB/RIF assay were calculated against the gold standard. Results: The Sensitivity, Specificity, PPV and NPV of ZN-stained sputum smear microscopy were 68.38%, 95.28%, 93.02% and 76.58% respectively, while for Xpert MTB/ RIF assay were 88.89%, 81.89%, 81.89% and 88.89% respectively. The results of the two diagnostic approaches were concordant with the gold standard with a kappa value of ZN 0.650 and 0.743 for Xpert MTB/RIF assay. Conclusion: This study concludes that the sensitivity of Xpert MTB/RIF assay was better than ZN-stained direct sputum smear microscopy for the diagnosis of pulmonary tuberculosis.

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Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay - Report from a third world country

Cited by 41 publications

References 14 publications

Diagnostic accuracy of xpert test in tuberculosis detection: A systematic review and meta-analysis

Diagnostic accuracy of xpert test in tuberculosis detection: A systematic review and meta-analysis

GeneXpert technology

Diagnostic Performance of Xpert MTB/RIF Assay Versus Ziehl-Neelsen Method for the Diagnosis of Pulmonary Tuberculosis in Addis Ababa, Ethiopia

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