https://doi.org/10.4081/monaldi.2024.2909
Role of GeneXpert in the diagnosis of extrapulmonary tuberculosis
Submitted: January 11, 2024
Accepted: July 15, 2024
Published: July 25, 2024
Accepted: July 15, 2024
Abstract Views: 252
PDF_EARLY VIEW: 133
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The World Health Organization endorsed the cartridge-based nucleic acid amplification test Xpert MTB/RIF (GXP) for the diagnosis of tuberculosis (TB). Studies about GXP efficiency in extrapulmonary TB (EPTB) are scarce. Hence, we decided to study the role of GXP in EPTB. This prospective observational study, conducted in the pulmonary medicine department of a tertiary care hospital after ethics committee permission, recruited 200 EPTB patients. The diagnosis of TB was achieved with the help of clinico-radiological correlation with microbiological test positivity. Acid-fast bacilli (AFB) culture was treated as the comparative gold standard. Patients who had no or incomplete data were excluded from the study. Data was analyzed to calculate the sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of TB and the detection of rifampicin resistance. The majority of cases were women (126 patients: 63%). The mean age was 23.71 years. On GXP, 130 (65%) had detected mycobacterium tuberculosis (MTB), and 70 (35%) did not. Adding AFB culture data, 168 (81.5%) showed microbiological evidence of TB, and 32 (18.5%) were negative. On the drug susceptibility test, 131 cases were rifampicin-sensitive, 32 were rifampicin-resistant TB, and in 5 cases, data was unavailable. The most common extrapulmonary site of involvement was the lymph node, with 94 patients (47%). The most common lymph node involved was the cervical lymph node, with 70 patients (74.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of GXP in EPTB collectively were 76.68%, 86.48%, 96%, and 45.7%, respectively. GXP is useful for the rapid detection of EPTB and the identification of rifampicin resistance, especially in a high-prevalence country like India.
World Health Organization. Global Tuberculosis Report 2023. Available from: https://www.who.int/publications/i/item/9789240083851. Accessed on: 19/04/2024.
Ministry of Health and Family Welfare. India TB report 2023. Available from: https://tbcindia.mohfw.gov.in/wp-content/uploads/2023/05/5646719104TB_AR_2023_04-04-2023_LRP_final.pdf. Accessed on: 19/04/2024.
Sharma SK, Ryan H, Khaparde Set al. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 2017;145:448-63.
Blakemore R, Story E, Helb D, et al. Evaluation of the analytical performance of the Xpert MTB/RIF assay. J Clin Microbiol 2010;48:2495-501.
DOI: https://doi.org/10.1128/JCM.00128-10
Chang K, Lu W, Wang J, et al. Rapid and effective diagnosis of tuberculosis and rifampicin resistance with Xpert MTB/RIF assay: a meta-analysis. J Infect 2012;64:580-8.
DOI: https://doi.org/10.1016/j.jinf.2012.02.012
Marlowe EM, Novak-Weekley SM, Cumpio J, et al. Evaluation of the Cepheid Xpert MTB/RIF assay for direct detection of Mycobacterium tuberculosis complex in respiratory specimens. J Clin Microbiol 2011;49:1621-3.
DOI: https://doi.org/10.1128/JCM.02214-10
World Health Organization. Rapid implementation of the Xpert MTB/RIF diagnostic test: technical and operational 'How-to'; practical considerations. 2011. Available from: https://www.who.int/publications/i/item/9789241501569. Accessed on: 19/11/2023.
Sharma SK, Mohan A, Kohli M. Extrapulmonary tuberculosis. Expert Rev Respir Med 2021;15:931-48.
DOI: https://doi.org/10.1080/17476348.2021.1927718
Chander V, Raina SK, Bhardwaj AK, et al. Clinico-epidemiological profile of extra pulmonary tuberculosis: a report from a high prevalence state of northern India. Public Health Res 2012;2:185-9.
DOI: https://doi.org/10.5923/j.phr.20120206.02
Sankar MM, Singh J, Diana SC, Singh S. Molecular characterization of Mycobacterium tuberculosis isolates from North Indian patients with extrapulmonary tuberculosis. Tuberculosis 2013;93:75-83.
DOI: https://doi.org/10.1016/j.tube.2012.10.005
Mohapatra PR, Janmeja AK. Tuberculous lymphadenitis. J Assoc Physicians India. 2009;57:585-90.
Ahmad NS, Khan S, Butt AS, et al. Rapid detection of Mycobacterium tuberculosis and Rifampicin resistance in extra pulmonary samples using Gene Xpert MTB/RIF assay. IOSR-JDMS 2014;13:2279-81.
DOI: https://doi.org/10.9790/0853-131145053
Avashia S, Bansal D, Ahuja K, Agrawal V. Comparison of conventional methods with gene xpertmtb/rif assay for rapid detection of mycobacterium tuberculosis and rifampicin resistance in extra-pulmonary samples. Int J Med Res Rev 2016;4:181-5.
DOI: https://doi.org/10.17511/ijmrr.2016.i02.010
Uppe A, Sawant S, Gupta D, Nair G. Comparison study of GENEXPERT versus TB MGIT culture in extra pulmonary tuberculosis. Am J Infect Dis 2020;8:1-3.
Mechal Y, Benaissa E, Benlahlou Y, et al. Evaluation of GeneXpert MTB/RIF system performances in the diagnosis of extrapulmonary tuberculosis. BMC Infect Dis 2019;19:1069.
DOI: https://doi.org/10.1186/s12879-019-4687-7
Sasikumar C, Utpat K, Desai U, Joshi J. Role of GeneXpert in the diagnosis of mycobacterium tuberculosis. Adv Respir Med 2020;88:183-8.
DOI: https://doi.org/10.5603/ARM.2020.0102
Habous M, Elimam MA, Kumar R, Deesi ZA. Evaluation of GeneXpert Mycobacterium tuberculosis/rifampin for the detection of Mycobacterium tuberculosis complex and rifampicin resistance in non-respiratory clinical specimens. Int J Mycobacteriol 2019;8:132-7.
DOI: https://doi.org/10.4103/ijmy.ijmy_83_19
Ministry of Health and Family Welfare. Report of the first national anti-tuberculosis drug resistance survey: India 2014–16, 2018. Available from: https://tbcindia.gov.in/WriteReadData/l892s/4187947827National%20Anti-TB%20Drug%20Resistance%20Survey.pdf. Accessed on: 19/11/ 2023.
Boehme CC, Nicol MP, Nabeta P, et al. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet 2011;377:1495-505.
DOI: https://doi.org/10.1016/S0140-6736(11)60438-8
Armand S, Vanhuls P, Delcroix G, et al. Comparison of the Xpert MTB/RIF test with an IS6110-TaqMan real-time PCR assay for direct detection of Mycobacterium tuberculosis in respiratory and nonrespiratory specimens. J Clin Microbiol 2011;49:1772-6.
DOI: https://doi.org/10.1128/JCM.02157-10
Causse M, Ruiz P, Gutierrez-Aroca JB, Casal M. Comparison of two molecular methods for rapid diagnosis of extrapulmonary tuberculosis. J Clin Microbiol 2011;49:3065-7.
DOI: https://doi.org/10.1128/JCM.00491-11
Tortoli E, Russo C, Piersimoni C, et al. Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis. Eur Respir J 2012;40:442-7.
DOI: https://doi.org/10.1183/09031936.00176311
Meldau R, Peter J, Theron G, et al. Comparison of same day diagnostic tools including Gene Xpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study. BMC Pulm Med 2014;14:58.
DOI: https://doi.org/10.1186/1471-2466-14-58
Massi MN, Biatko KT, Handayani I, et al. Evaluation of rapid GeneXpert MTB/RIF method using DNA tissue specimens of vertebral bones in patients with suspected spondylitis TB. J Orthop 2017;14:189-91.
DOI: https://doi.org/10.1016/j.jor.2016.12.003
Held M, Laubscher M, Zar HJ, Dunn RN. GeneXpert polymerase chain reaction for spinal tuberculosis: an accurate and rapid diagnostic test. Bone Joint J 2014;96:1366-9.
DOI: https://doi.org/10.1302/0301-620X.96B10.34048
Rathi P, Gambhire P. Abdominal tuberculosis. J Assoc Physicians India 2016;64:38-47.
Saeed M, Ahmad M, Iram S, et al. GeneXpert technology: a breakthrough for the diagnosis of tuberculous pericarditis and pleuritis in less than 2 hours. Saudi Med J 2017;38:699-705.
DOI: https://doi.org/10.15537/smj.2017.7.17694
Ethics Approval
ECARP/PG Dissertation Approval/2021 by academic institutional ethics committee.How to Cite
Desai, Unnati, Saby AK, Ketaki Utpat, and Jyoti Bacche. 2024. “Role of GeneXpert in the Diagnosis of Extrapulmonary Tuberculosis”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2024.2909.
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Nitin Goel, Nitesh Goyal, Ravishankar Nagaraja , Raj Kumar, Systemic corticosteroids for management of ‘long-COVID’: an evaluation after 3 months of treatment , Monaldi Archives for Chest Disease: Vol. 92 No. 2 (2022)
- Nitin Goel, Nitesh Goyal, Raj Kumar, Exertional dyspnea and hemoptysis in an adolescent: is it tuberculosis only? , Monaldi Archives for Chest Disease: Vol. 91 No. 1 (2021)
- G.B. Migliori, R. Centis, C. Lange, A. Matteelli, D. Cirillo, Tuberculosis, one disease, many faces , Monaldi Archives for Chest Disease: Vol. 69 No. 1 (2008): Pulmonary series
- Kranti Garg, Karan Sharma, Aditi Gupta, Vishal Chopra, Association of cycle threshold values of CBNAAT with severity and outcome in COVID-19 , Monaldi Archives for Chest Disease: Vol. 91 No. 4 (2021)
- G. Caramori, D. Artioli, G. Ferrara, R. Cazzuffi, C. Pasquini, M. Libanore, V. Guardigni, I. Guzzinati, M. Contoli, R. Rossi, R. Rinaldi, C. Contini, A. Papi, Severe pneumonia after intravesical BCG instillation in a patient with invasive bladder cancer: case report and literature review , Monaldi Archives for Chest Disease: Vol. 79 No. 1 (2013): Pulmonary series
- A. Poyraz, D. Kilic, A. Hatipoglu, T. Bakirci, B. Bilezikci, Pedunculated solitary fibrous tumours arising from the pleura , Monaldi Archives for Chest Disease: Vol. 65 No. 3 (2006): Pulmonary series
- Kranti Garg, Preeyati Chopra, Jasmin Garg, Deepak Goyal, Darshana KE, Vishal Chopra, Psychological morbidity and quality of life of patients with pulmonary tuberculosis , Monaldi Archives for Chest Disease: Early Access
- Yuvarajan Sivagnaname, Praveen Radhakrishnan, Antonius Maria Selvam, Malignant bronchial ulcer with coexistent pulmonary tuberculosis , Monaldi Archives for Chest Disease: Vol. 89 No. 3 (2019)
- Anna Jacob, Kranti Garg, Kashish Dutta, Varinder Saini, Deepak Aggarwal, Ajeet Sidana, Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease , Monaldi Archives for Chest Disease: Early Access
- Shayan Shahid, Ali bin Abdul Jabbar, Abdullah Wagley, Muhammad Daniyal Musharraf, Haris Zahid, Syed Muhammad Zubair, Muhammad Irfan, Non-cystic fibrosis bronchiectasis: a retrospective review of clinical, radiological, microbiological and lung function profile at a tertiary care center of low-middle income country , Monaldi Archives for Chest Disease: Early Access
You may also start an advanced similarity search for this article.
