Tuberculosis-Specific Antigen/Phytohemagglutinin Ratio Combined With GeneXpert MTB/RIF for Early Diagnosis of Spinal Tuberculosis: A Prospective Cohort Study

Abstract

Spinal tuberculosis (TB), the most common form of musculoskeletal tuberculosis, is an infection-related disease globally, with paraplegia occurring in severe cases. Therefore, identification of spinal TB at an early stage is important for early intervention and eventual therapy. In this study, we conducted a prospective cohort study in routine clinical practice to investigate the diagnosis of different TB tests. A total of 519 patients were recruited based on the radiology of spinal TB. The diagnostic model was computed by regression analysis and was determined by receiver operating characteristic (ROC) curve analysis. Specificity, sensitivity, predictive value, likelihood ratio, and accuracy were also computed and compared. GeneXpert MTB/RIF showed a higher positive rate compared to that in the acid-fast bacilli smear and Mycobacterium culture. The results also showed that the Mycobacterium tuberculosis-specific antigen/phytohemagglutinin ratio in the T-SPOT assay had a good performance in the preoperative diagnosis and prediction of spinal TB. The diagnostic model based on the ratio of tuberculosis-specific antigen/phytohemagglutinin combined with GeneXpert MTB/RIF showed better efficiency for spinal TB diagnosis. In summary, the tuberculosis-specific antigen/phytohemagglutinin ratio combined with GeneXpert MTB/RIF could provide an early diagnosis of spinal TB.

Analysis of the diagnostic efficacy of the QuantiFERON-TB Gold In-Tube assay for preoperative differential diagnosis of spinal tuberculosis

“…Therefore, early diagnosis and regular antituberculosis treatment are of great importance for improving the prognosis of patients with spinal tuberculosis ( Go et al., 2012 ; Wang et al., 2020 ). Currently, spinal tuberculosis is often diagnosed on the basis of postoperative microbial culture ( Perronne et al., 1994 ), the GeneXpert MTB/RIF system ( Patel et al., 2020 ; Qi et al., 2022 ), and metagenomic next-generation sequencing (mNGS) ( Shi et al., 2020 ; Sun et al., 2021 ). These diagnostic techniques require invasive tests or open surgery to obtain specimens, often delaying the patient’s confirmation of the diagnosis.…”

A predictive model for early clinical diagnosis of spinal tuberculosis based on conventional laboratory indices: A multicenter real-world study

“…In published studies, we noted that Liyi Chen et al ( 2022) also attempted early diagnosis of spinal tuberculosis by drawing columnar maps, but they included fewer variables and lacked specific indicators for the diagnosis of spinal tuberculosis (IGRAs, TB antibody), and they did not develop strict inclusion and diagnostic criteria. A prospective study published in 2022 also diagnosed STB by combining multiple indicators, but we observed that this study included diagnostic indicators such as Xpert, acid-fast staining, and other indicators that occur late in the patient's hospitalization (Qi et al, 2022); therefore, this study did not focus on the early diagnosis of STB. In addition, a recent study focused on a deep learning model for early diagnosis of spinal tuberculosis using imaging data analysis to determine the early diagnosis of spinal tuberculosis , whereas our study focused on routine laboratory findings.…”

Current landscape of exosomes in tuberculosis development, diagnosis, and treatment applications

“…Spinal TB is a common manifestation of extrapulmonary and osteoarticular TB, with severe neurological deficits and paraplegia. Early diagnosis of spinal TB is extremely important for controlling the progression of the disease, shortening the course of treatment, and preventing severe spinal deformities ( 78 ). Sun et al.…”