Xpert MTB/RIF Ultra and Xpert MTB/RIF for diagnosis of tuberculosis in an HIV-endemic setting with a high burden of previous tuberculosis: a two-cohort diagnostic accuracy study

Publication date: Available online 14 February 2020Source: The Lancet Respiratory MedicineAuthor(s): Hridesh Mishra, Byron W P Reeve, Zaida Palmer, Judy Caldwell, Tania Dolby, Charissa C Naidoo, Jennifer G Jackson, Samuel G Schumacher, Claudia M Denkinger, Andreas H Diacon, Paul D van Helden, Florian M Marx, Robin M Warren, Grant TheronSummaryBackgroundXpert MTB/RIF Ultra (Ultra) is a new test for tuberculosis undergoing global roll-out. We assessed the performance of Ultra compared with Xpert MTB/RIF (Xpert) in an HIV-endemic setting where previous tuberculosis is frequent and current test performance is suboptimal.MethodsIn this two-cohort diagnostic accuracy study, we used sputum samples from patients in South Africa to evaluate the accuracy of Ultra and Xpert against a single culture reference standard. For the first cohort (cohort A), we recruited adults (aged ≥18 years) with symptoms of presumptive tuberculosis at Scottsdene clinic in Cape Town, South Africa. We collected three sputum samples from each patient in cohort A, two at the first visit of which one was tested using Xpert and the other was tested using culture, and one sample the next morning which was tested using Ultra. In a separate cohort of patients with presumptive tuberculosis and recent previous tuberculosis (≤2 years) who had submitted sputum samples to the National Health Laboratory Services (cohort B), decontaminated sediments were, after processing, randomly allocated (1:1) for testing with Ul...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research

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Abstract Diagnosis tuberculosis (TB) in endemic countries is challenging due to high caseloads and limited resources. A simple, cost-effective diagnostic test for rapid detection of Mycobacterium tuberculosis in clinical specimens is in need. In Thailand, we evaluated the performance of in-house loop-mediated isothermal amplification (LAMP) targeting M. tuberculosis 16s rRNA gene for TB diagnosis. A total of 252 sputum samples from pulmonary TB suspects were analyzed. The sensitivity of LAMP was 99.04% (103/104; 95% confidential interval [CI]: 94.76-99.98%) and 72.73% (16/22; 95% CI: 49.78-89.27) for smear-positiv...
Source: Japanese Journal of Infectious Diseases - Category: Infectious Diseases Authors: Tags: Jpn J Infect Dis Source Type: research
ConclusionA high suspicion level for TB, the early diagnosis and the prompt initiation of therapy could increase the survival rates among SOT patients. Overall, renal and lung TRs appear to have a higher predisposition for acquiring TB than other type of recipients. Monitoring of the high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection among TRs especially in endemic areas.
Source: Microbial Pathogenesis - Category: Infectious Diseases Source Type: research
Conclusions: The results show that intricate TB cases were notified by the local health services. Strategies of surveillance and articulation with these health services seem to contribute to the identification of TB cases among PDL.
Source: The Journal of Infection in Developing Countries - Category: Infectious Diseases Source Type: research
Conclusion: Patient with ABPA frequently received empiric ATT as smear –ve TB in high TB burden country. This results in over diagnosis of TB and unnecessary use of global resource. Moreover dealy in diagnosis leads to long term complications. Awareness regarding ABPA is required in high TB burden countries.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Tuberculosis Source Type: research
Conclusion: Significant amount of PCLL were malignant in nature with low AFB smear positive rate. R-EBUS guided transbronchial biopsy has high diagnostic yield for PCLL with good safety profile.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional pulmonology Source Type: research
Authors: Çulha G, Kaya T, Gülbol Duran G, Urhan Küçük M, Doğramacı AÇ, Tiyekli Çelik D Abstract Leishmaniasis is a parasitic disease that is transmitted to humans by the bites of infected female phlebotomine sandflies. In the diagnosis of cutaneous leishmaniasis (CL), in the smear samples, the demonstration of the parasite by microscope remains a gold standard method. However, it becomes difficult to diagnose the parasite since the number of amastigotes in chronic cases with a lesion of one year or longer is very low. Due to many factor such as patients primarily do not ...
Source: Mikrobiyoloji Bulteni - Category: Microbiology Tags: Mikrobiyol Bul Source Type: research
Pulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination f...
Source: BMC Infectious Diseases - Category: Infectious Diseases Authors: Tags: Research article Source Type: research
Tuberculosis (TB) remains a leading killer among infectious diseases of humans worldwide. Delayed diagnosis is a crucial problem in global TB control programs. Bacteriological methods currently used to diagnose TB in endemic countries take up to 8 weeks, which poses a significant delay in starting antibiotic therapy. The presence of a heterogeneous population of Mycobacterium tuberculosis, the causative agent of TB, is among the reasons for delayed diagnosis by bacteriological methods. Previously, it has been shown that mycobacterial resuscitation-promoting factors (RPFs), a family of proteins secreted by actively growing ...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Authors: Mthiyane T, Peter J, Allen J, Connolly C, Davids M, Rustomjee R, Holtz TH, Malinga L, Dheda K Abstract Background: Based on current WHO guidelines, hospitalized tuberculosis (TB) and HIV co-infected patients with CD4 count
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
CONCLUSIONS: Ultrasound evaluation of the spleen in patients with HIV and symptoms suggestive of TB in endemic regions is a viable diagnostic adjunct. Ultrasound detection of splenic microabscesses in HIV patients is probably sufficient indication to initiate TB treatment prior to obtaining culture data. Strong conclusions cannot be drawn owing to the high heterogeneity of this small number of studies. PMID: 31456550 [PubMed - in process]
Source: South African Medical Journal - Category: African Health Tags: S Afr Med J Source Type: research
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