Also, prevalence of TB was significantly (P < 0.05) higher among HIV negative 25 (9.6%) than HIV positive 23 (8.8%) patients. The first Xpert detected rifampin resistance in 5 of 7 (71.4%; 95% CIs, 35.9–91.8%) culture-confirmed rifampin resistance cases. g There were 25, 2, 3, 21, 3, and 22, respectively, participants whose presence of night sweats was unknown. PA One Xpert predicted the absence of culture-positive tuberculosis with an NPV of 97.6%, and predicted the absence of smear-positive tuberculosis with an NPV of 99.7%. In the 1 participant with false-positive Xpert rifampin resistance testing, the first Xpert indicated rifampin resistance, but the second did not. All participants provided 2 sputum specimens for AFB smear with fluorescent staining and mycobacterial culture (using both liquid and solid media), conducted according to the local standard of care. To view other topics, please sign in or purchase a subscription. 2018 Feb;153(2):467-497. doi: 10.1016/j.chest.2017.11.018. Sputum samples were collected from 261 suspected TB patients and analyzed in the laboratory using GeneXpert, ZN test and culture. Xpert was authorized by the US Food and Drug Administration (FDA) in 2013 for detection of M. tuberculosis and reporting of rifampin resistance directly from sputum samples [3] and as an aid in decisions regarding respiratory isolation in 2015 [4]. Munir et al.5 in their study reported GeneXpert MTB/RIF assay as an effective tool for early diagnosis and treatment of TB. All other authors report no potential conflicts. Amplification methods: GeneXpert MTB/RIF: highly sensitive and specific for detecting TB and RIF resistance directly in sputum. When compared to MTB culture by the LJ medium, GeneXpert MTB/RIF is less sensitive but a technique with more rapid and specific results readily available. Invalid results (n = 20) and missing results due to site or laboratory errors (n = 2) were excluded. For those with HIV infection, a second Xpert may be quite important for prompt diagnosis regardless of smear status given the morbidity and mortality associated with HIV/tuberculosis coinfection. ���ʦBw���6*(k�n�v��A��>�T�k��o�tz�7��Bҿ�iQ�h�y�f����YN^�V-�������U�{�˧oy���ꀠ�k���&�*��)�b��/ci�5�n����!�lp�@�P:�]��\M�� Ui)S���py��6>ز_�Y9���xЖ� Ӭ�P�����9l�{�\����blh��q�Y�1���_��j5x^ � �V��3�)��N\�ik�q� �ʄ��NO�j~�/��nGN;beMY�fE3O{z���\�-��p�Z, �n'�|@D$H��Z��L�a��h�7c�:c���p�9%���|�;&[n�;o�{]S�d�F�z���4D�[���a +�$1p�mW$�k� ��4W�S��F�f�ypikyi��P��ߙ���W��X�Y�°����PD�qGrR�U͹:� ձ��0T�-�Y�5r�{� `X7-�H9�koWs�輼Gߞ��P?�N M�ၣ�"N�� The efficiency of MTB culture using the LJ medium has been demonstrated to detect MTB when 10 viable bacilli per mL of sputum were present.5 GeneXpert MTB/RIF assay is one of the most advanced and rapid PCR-based methods recommended by WHO in 2010 for the detection of MTB DNA and rifampicin resistance. . f AFB+ in 31 of 50 (62.0%) for 1 Xpert assay comparison and 32 of 52 (61.5%) for 2 Xpert assays comparison. For drug-susceptible TB, typically four drugs used for 8 wks, then using susceptibilities reduce to 2 or 3 drugs (usually. Frequency distribution graph showing the locality of participants in the study population. Reechaipichitkul W, Suleesathira T, Chaimanee P. Southeast Asian J Trop Med Public Health. The smear was air dried followed by heat fixation and staining using ZN staining methods. Direct smears were prepared for microscopic examination of AFB by applying one drop of sputum samples on a clean glass slide which was labeled with the ID number. Members of _ can log in with their society credentials below, International Journal of Immunopathology and Pharmacology, Ghulam Rasool, Arif Muhammad Khan, Raza Mohy-Ud-Din, and Muhammad Riaz, This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (. Steingart A sputum sample is collected from the patient with suspected TB. For 2 Xperts, 3 failed cultures, 7 missing cultures due to site/laboratory error, and 2 invalid Xpert results were excluded. The GeneXpert MTB/RIF assay was evaluated with microscopically negative and positive pulmonary and extrapulmonary specimens from patients with substantial clinical indications for tuberculosis. Author contributions. MTB culture verified the results of GeneXpert MTB/RIF assay for the detection of MTB. Table 1. COMPARISON OF GeneXpert MTB/RIF ASSAY WITH CONVENTIONAL AFB SMEAR FOR DIAGNOSIS OF PULMONARY TUBERCULOSIS IN NORTHEASTERN THAILAND. h Participants may have >1 abnormal CXR finding. For more information view the SAGE Journals Article Sharing page. In previous studies, Xpert demonstrated a pooled specificity of 99% and sensitivity of 98% in acid-fast bacilli smear-positive (AFB+) and 67% in AFB smear-negative (AFB–) sputum specimens in mostly high-tuberculosis-prevalence settings [1]. Diagnosis of smear-negative tuberculosis is greatly improved by Xpert MTB/RIF. Less sensitive in smear-negative and extra-pulmonary specimens due to a lower bacillary burden. Sensitivity of Xpert MTB/RIF Assay Versus 2 or 3 Acid-Fast Bacilli Smears for Identification of US Culture-Confirmed Tuberculosis Cases. Thank you for submitting a comment on this article. May cause LFT abnormalities, especially cholestatic picture. CXR: upper lobe infiltrate(s) classic (often cavitary); atypical presentations especially in children or if HIV+; hilar adenopathy. Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. Peer review under responsibility of Alexandria University Faculty of Medicine. Sensitivity was 98.5% in AFB+ and 54.8% in AFB– participants.

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