Diagnostic performance of the Xpert MTB/RIF assay for tuberculous lymphadenitis on fine needle aspirates from Ethiopia
Abstract
The Xpert MTB/RIF (Xpert) test is a novel automated molecular diagnostic recently endorsed by the World Health Organization for rapid diagnosis of tuberculosis (TB). Nevertheless, performance related data from high TB prevalence regions to investigate clinically suspected TB lymphadenitis are limited. To evaluate the performance of Xpert test for direct detection of the Mycobacterium tuberculosis complex (MTBC) and rifampicin (RIF) resistance in lymph node aspirates, a cross-sectional study was conducted at four main hospitals in northern Ethiopia. Culture served as a reference standard for growth of MTBC and phenotypic and MTBDRplus drug susceptibility testing for detecting RIF resistance. Two-hundred-thirty-one fine needle aspirate (FNAs) specimens were processed simultaneously for smear, culture, and Xpert test. When compared to culture, the Xpert test correctly identified 29 out of 32 culture positive cases, 5 out of 11 contaminated cases, and 56 out of 188 culture negative cases. The overall sensitivity of the test was 93.5% [95% CI, 78.3-98.9%] and specificity 69.2% [95% CI, 66.4-70.0%]. The Xpert test identified the rpoB mutations associated with RIF resistance concordant with GenoType MTBDRplus and phenotypic drug susceptibility testing. In conclusion, the Xpert assay was found to perform well in detecting MTBC and RIF resistance in TB lymphadenitis patients. Furthermore, the test is simple and suitable to use in remote and rural areas for the diagnosis of TB lymphadenitis directly from FNAs in Ethiopia where TB/MDR-TB is rampant.
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The specificity of Xpert in the current study is higher than that reported by Biadigilegn et al. (69.2%).
“The specificity (91%) of the Xpert in the current study was found to be consistent with previous studies reported by others (specificity, 89–99%) [20,21,22], but higher than the study done by Biadigilegn et al (specificity, 69.2%) [13].”
From GeneXpert MTB/RIF Assay for the Diagnosis of Tuberculous Lymphadenitis on Concentrated Fine Needle Aspirates in High Tuberculosis Burden Settings (2015) · cites this paper as [13]
Previous studies reported 98-100% agreement in detection of rifampicin resistance strains using the Xpert test and phenotypic drug susceptibility test.
“Previous studies reported 98–100% agreement in detection of rifampicin resistance strains using the Xpert test and phenotypic drug susceptibility test [13,14,18,26].”
From GeneXpert MTB/RIF Assay for the Diagnosis of Tuberculous Lymphadenitis on Concentrated Fine Needle Aspirates in High Tuberculosis Burden Settings (2015) · cites this paper as [13]
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- Authors
- Biadglegne, F., Mulu, A., Rodloff, A. C., & Sack, U.
- Affiliations
- University Hospital Leipzig (DE)
- Venue
- Tuberculosis
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 94
- Issue
- 5
- Pages
- 502-505
- ISSN
- 1472-9792 (ISSN-L)
- OpenAlex
- W2038380854
- Cited by
- 35
- References
- 19
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 2
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Tuberculosis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutscher Akademischer Austauschdienst
- Bundesministerium für Bildung und Forschung (1315883)
- Bahir Dar University
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
- Keywords
- Xpert MTB/RIF, tuberculous lymphadenitis, Mycobacterium tuberculosis complex, rifampicin resistance, fine needle aspirate, molecular tuberculosis diagnosis, diagnostic accuracy, rpoB mutations, GenoType MTBDRplus, drug susceptibility testing, cultural comparison, Ethiopia
- MeSH terms
- Adolescent, Antitubercular Agents, Bacterial Proteins, Cells, Cultured, Cross-Sectional Studies, DNA Mutational Analysis, Ethiopia, Female, Genotype, Humans, Lymph Nodes, Male, Microbial Sensitivity Tests, Mutation, Mycobacterium tuberculosis, Phenotype, Predictive Value of Tests, Reagent Kits, Diagnostic, Rifampin, DNA-Directed RNA Polymerases, Tuberculosis, Lymph Node, Prevalence, Tuberculosis, Multidrug-Resistant, Drug Resistance, Bacterial, Biopsy, Fine-Needle, Real-Time Polymerase Chain Reaction
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