Challenges in the Diagnosis of Extrapulmonary Tuberculosis: Role of Gene Xpert Mycobacterium Tuberculosis/Rifampicin Assay
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 7
Abstract
Introduction: Extrapulmonary tuberculosis (EPTB) accounts for about 25% of all cases of active TB. Difficulty in sampling from the extrapulmonary sites and the paucibacillary nature of the specimens make EPTB a diagnostic challenge. Xpert mycobacterium TB (MTB) /rifampicin (RIF) is a fully automated diagnostic test which simultaneously detects TB and RIF drug resistance within few hours. Aim: The aim is to study the diagnostic role of gene Xpert MTB/RIF in cases of EPTB. Materials and Methods: All the specimens from patients diagnosed to have EPTB with a composite reference standard (CRS) were subjected to Xpert MTB/RIF. The CRS included parameters such as smear, culture, histology, and cytology reports (for biopsy samples and aspirates, respectively), biochemical tests such as adenosine deaminase levels (for pleural fluid, ascitic fluid, and cerebrospinal fluid [CSF]), and response to treatment during follow-up visits. Results: Of 108 EPTB cases, maximum 51 (47.2%) were cases of lymph node TB, followed by TB pleural effusion 38 (35.1%), abdominal Koch’s 12 (11.1%), and TB meningitis 7 (6.4%). The sensitivity of Xpert MTB/RIF for lymph node specimens was observed to be 62.7%, for pleural fluid 31.5%, and for ascitic fluid 41.6%. None of the CSF samples was reported MTB positive, of 7 by Xpert MTB/RIF. Conclusion: Xpert MTB/RIF results may not be fully satisfactory from the clinical point of view. However, test should still be done because of its simplicity, reliability, and rapid results. Not only MTB detection but also rapidly determining the patient’s multidrug-resistant tuberculosis status in such cases is of prime importance. However, the result should be adjunct to the results of other prevalent techniques of diagnosis of EPTB.
Authors and Affiliations
Amol B Fuladi, Piyush P Gupta
Keywords
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