Diagnostic Evaluation of Multiplex Real Time PCR, GeneXpert MTB/RIF Assay and Conventional Methods in Extrapulmonary Tuberculosis
Journal Title: Journal of Clinical and Diagnostic Research - Year 2019, Vol 13, Issue 1
Abstract
ABSTRACT Introduction: Effective management of Extrapulmonary Tuberculosis (EPTB) requires simultaneous identification of Mycobacterium tuberculosis (M.tuberculosis) complex, Non-Tuberculous Mycobacteria (NTM) and Rifampicin (RIF) sensitivity pattern for early and effective evidence based Antitubercular Treatment (ATT). Aim: To evaluate the diagnostic potential of multiplex Real-Time Polymerase Chain Reaction (mRT-PCR) versus GeneXpert and conventional microscopy and culture. Materials and Methods: A total of 110 multivaried extrapulmonary specimens from an equal number of patients with strong clinical/radiological/histopatholgical evidence of EPTB were subjected to conventional microscopy, liquid culture MGIT 960 system, GeneXpert and mRT-PCR. Results: Highest positivity of 88.8% (97/110) was shown by mRT-PCR followed by GeneXpert (52.72%, 58/110), liquid culture MGIT 960 system (44.54%, 49/110) and microscopy (4.54%, 5/110), (p<0.01, χ2=156). Comparing it with culture positive cases (n=49), the sensitivity, specificity, Positive and Negative Predictive Value (PPV and NPV) of GeneXpert was found to be 87.25%, 100%, 100% and 80.64% respectively while the same parameters were 100% each for mRT-PCR. mRT-PCR showed higher positivity over GeneXpert in various individual extrapulmonary sample category with significant difference seen in synovial fluid. The specific added advantage of mRT-PCR was seen in the detection of 17 NTM. GeneXpert advantage seen in detection of five cases of RIF resistance. Conclusion: With individual feature of detection of NTM by mRT-PCR and RIF resistance by GeneXpert, this study may advocate the use of mRT-PCR adjunct to GeneXpert in the diagnostic armamentarium to identify more rapidly and effectively both M.tuberculosis and NTM along with RIF resistance information for early and specific ATT intervention of all EPTB cases including Multi Drug Resistant (MDR). However, further research may be required to enhance the sensitivity of both GeneXpert and mRT-PCR to exclude all possibilities of false negative EPTB cases.
Authors and Affiliations
Sanjay Singh Negi, Priyanka Singh, Sachin Chandrakar, Ujjwala Gaikwad, Padma Das, Anudita Bhargava, Ajoy Behra, Nitin M Nagarkar
Keywords
Related Articles
- EP ID EP557424
- DOI 10.7860/JCDR/2019/37569.12485
- Views 113
- Downloads 0
Facial Dysmorphism: An Unreported Teratogenicity with Levetiracetam
Levetiracetam (LEV) is a relatively newer anticonvulsant drug used to treat epilepsy and is approved by United States Food and Drugs Administration (USFDA). The drug binds to a synaptic vesicle glycoprotein and inhibits...
Role of Gamma Glutamyl Transferase in the Diagnosis of Metabolic Syndrome in Patients with Hypothyroidism
ABSTRACT Introduction: Hypothyroidism is the most prevalent thyroid disorder in India that affects one in ten adults. Gamma Glutamyl Transferase (GGT) is an ectopic enzyme associated with oxidative stress in various dise...
A Rare Case of Intestinal Malrotation and Volvulus of Jejunum with Coexisting Carcinoid Tumour of Appendix
Malrotation of the midgut is generally regarded as a paediatric pathology. It is rare in adults. Patients may present with symptoms of acute bowel obstruction or chronic abdominal pain. Barium study, Contrast Enhanced Co...
Right Pulmonary Venous Atresia: A Rare Cause for Recurrent Unilateral Pneumonia
Recurrent unilateral pneumonia poses a diagnostic dilemma for all paediatricians. Isolated pulmonary venous atresia is an uncommon entity, which presents with recurrent unilateral pulmonary infections, dyspnoea on exerti...
Nomophobia: A Cross-sectional Study to Assess Mobile Phone Usage Among Dental Students
Introduction: Mobile phones were originally seen as a gadget for communication but currently, the internet enabled mobile phones have become an integral part of our daily life. Their benefits are incomparable but at the...