Xpert MTB/RIF Ultra improved the diagnosis of paucibacillary tuberculosis: A prospective cohort study

Wang, Guirong; Wang, Shuqi; Jiang, Guanglu; Yang, Xinting; Huang, Mailing; Huo, Fengmin; Ma, Yifeng; Dai, Guangming; Liu, Weimin; Chen, Xiaoyou; Huang, Hairong

doi:10.1016/j.jinf.2019.02.010

Cited by 63 publications

(55 citation statements)

References 15 publications

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“…Previous studies have suggested that Xpert Ultra is significantly more sensitive than Xpert for the diagnosis of tuberculous meningitis. 12,13 In their cohort of 23 HIV co-infected patients with definite or probable tuberculous meningitis, Bahr and colleagues reported sensitivities of 69•6% for Xpert Ultra and 43•5% for Xpert, compared with 81•8% and 83•3%, respectively, in the HIV coinfected patients included in our study. What might be the explanation for these different results?…”

Section: Discussionmentioning

confidence: 49%

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study

Donovan

Thu

Phu

et al. 2020

The Lancet Infectious Diseases

116

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Background Xpert MTB/RIF Ultra (Xpert Ultra) might have higher sensitivity than its predecessor, Xpert MTB/RIF (Xpert), but its role in tuberculous meningitis diagnosis is uncertain. We aimed to compare Xpert Ultra with Xpert for the diagnosis of tuberculous meningitis in HIV-uninfected and HIV-infected adults. Methods In this prospective, randomised, diagnostic accuracy study, adults (≥16 years) with suspected tuberculous meningitis from a single centre in Vietnam were randomly assigned to cerebrospinal fluid testing by either Xpert Ultra or Xpert at baseline and, if treated for tuberculous meningitis, after 3-4 weeks of treatment. Test performance (sensitivity, specificity, and positive and negative predictive values) was calculated for Xpert Ultra and Xpert and compared against clinical and mycobacterial culture reference standards. Analyses were done for all patients and by HIV status.

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Section: Discussionmentioning

confidence: 49%

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study

Donovan

Thu

Phu

et al. 2020

The Lancet Infectious Diseases

116

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“…The study also included 71 fine-needle aspirations of tissues for which the detection rate of Ultra and Xpert was 78.9% and 63.4%, respectively; this was slightly higher than that of pleural fluid. Among smear-negative specimens, the sensitivity of Ultra and Xpert on pleural fluid (n ¼ 108) was 61.11% versus 34.26% [31].…”

Section: Performance For the Diagnosis Of Extrapulmonary Tuberculosismentioning

confidence: 99%

“…Ultra and Xpert were not initially considered for CSF but have been tested in several studies. Wang and colleagues observed an increased sensitivity of Ultra (44.19%) when compared with Xpert (18.60%) on CSF of HIV-negative patients (n ¼ 43 patients with tuberculous meningitis) [31]. In another study performed in HIV-positive patients (n ¼ 23 patients with probable or definite tuberculous meningitis), the sensitivity of Ultra and Xpert for the diagnosis of tuberculous meningitis in HIV positive patients was 70% and 43%, respectively ( Table 1, Fig.…”

Section: Tuberculous Meningitismentioning

confidence: 99%

The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection

Opota

Mazza-Stalder

Greub

et al. 2019

Clinical Microbiology and Infection

105

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“…8 Four additional small studies on CSF (containing a minimum of four and a maximum of 43 samples) corroborated the increased sensitivity of Xpert Ultra. [17][18][19][20] Additional larger studies using realtime CSF samples and prespecified reference standards are needed to better inform the current understanding of Xpert Ultra's performance in tuberculous meningitis.…”

Section: Introductionmentioning

confidence: 99%

Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study

Cresswell

Tugume

Bahr

et al. 2020

The Lancet Infectious Diseases

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Introduction Tuberculous meningitis accounts for 1-5% of tuberculosis cases. Diagnostic delay contributes to poor outcomes. We evaluated the performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis diagnosis. Methods In this prospective validation study, we tested the cerebrospinal fluid (CSF) of adults presenting with suspected meningitis (ie, headache or altered mental status with clinical signs of meningism) to the Mulago National Referral Hospital and Mbarara Regional Referral Hospital in Uganda. We centrifuged the CSF, resuspended the cell pellet in 2 mL CSF, and tested 0•5 mL aliquots with Xpert Ultra, Xpert MTB/RIF (Xpert), and mycobacterial growth indicator tube (MGIT) culture. We quantified diagnostic performance against the uniform case definition of probable or definite tuberculous meningitis and a composite microbiological reference standard. Findings From Nov 25, 2016, to Jan 24, 2019, we screened 466 adults with suspected meningitis and tested 204 for tuberculous meningitis. Uniform clinical case definition classified 51 participants as having probable or definite tuberculous meningitis. Against this uniform case definition, Xpert Ultra had 76•5% sensitivity (95% CI 62•5-87•2; 39 of 51 patients) and a negative predictive value of 92•7% (87•6-96•2; 153 of 165), compared with 55•6% sensitivity (44•0-70•4; 25 of 45; p=0•0010) and a negative predictive value of 85•8% (78•9-91•1; 121 of 141) for Xpert and 61•4% sensitivity (45•5-75•6; 27 of 44; p=0•020) and negative predictive value of 85•2% (77•4-91•1; 98 of 115) for MGIT culture. Against the composite microbiological reference standard, Xpert Ultra had sensitivity of 92•9% (80•5-98•5; 39 of 42), higher than Xpert at 65•8% (48•6-80•4; 25 of 38; p=0•0063) and MGIT culture at 72•2% (55•9-86•2; 27 of 37; p=0•092). Xpert Ultra detected nine tuberculous meningitis cases missed by Xpert and MGIT culture. Interpretation Xpert Ultra detected tuberculous meningitis with higher sensitivity than Xpert and MGIT culture in this HIV-positive population. However, with a negative predictive value of 93%, Xpert Ultra cannot be used as a ruleout test. Clinical judgment and novel highly sensitive point-of-care tests are still required.

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Xpert MTB/RIF Ultra improved the diagnosis of paucibacillary tuberculosis: A prospective cohort study

Cited by 63 publications

References 15 publications

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study

The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection

Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study

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