Evaluation of Xpert MTB/RIF for detection of tuberculosis from blood samples of HIV-infected adults confirms Mycobacterium tuberculosis bacteremia as an indicator of poor prognosis
Open accessAbstract
Tuberculosis (TB) remains a leading cause of death among HIV-infected adults, in part because of delayed diagnosis and therefore delayed initiation of treatment. Recently, the Gene-Xpert platform, a rapid, PCR-based diagnostic platform, has been validated for the diagnosis of TB with sputum. We have evaluated the Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis bacteremia and investigated its impact on clinical outcomes. Consecutive HIV-infected adults with fever and cough presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, were recruited and followed up for 2 months. At presentation, three sputum samples were examined by smear, culture, and Xpert MTB/RIF assay for the presence of M. tuberculosis and blood was drawn for PCR with Xpert, for mycobacterial culture (Myco/F Lytic), and for aerobic culture. One hundred four patients were recruited, and 44 (43%) were sputum culture positive for M. tuberculosis. Ten were Xpert blood positive, for a sensitivity of 21% and a specificity of 100%. The 2-week mortality rate was significantly higher among patients who were Xpert blood positive than among those who were negative (40% versus 3%; multivariate odds ratio [OR] for death if positive, 44; 95% confidence interval [CI], 3 to 662). This effect persisted on assessment of the mortality rate at 2 months (40% versus 11%; OR, 5.6; 95% CI, 1.3 to 24.6). When screening uncomplicated patients presenting with a productive cough for pulmonary TB, Xpert blood offers no diagnostic advantage over sputum testing. Despite this, Xpert blood positivity is highly predictive of early death and this test rapidly identifies a group of patients in urgent need of initiation of treatment.
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In blood, Xpert MTB/RIF sensitivity against culture in Feasey 2013 was 56% (21 to 86).
“Xpert MTB/RIF sensitivity and specificity against culture were 56% (21 to 86) and 94% (85 to 98) (1 study; 74 participants, 9 (12.2%) with tuberculosis (Feasey 2013)); Appendix 10.”
From Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults (2021) · cites this paper as Feasey 2013
In blood, Xpert MTB/RIF specificity against culture in Feasey 2013 was 94% (85 to 98).
“Xpert MTB/RIF sensitivity and specificity against culture were 56% (21 to 86) and 94% (85 to 98) (1 study; 74 participants, 9 (12.2%) with tuberculosis (Feasey 2013)); Appendix 10.”
From Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults (2021) · cites this paper as Feasey 2013
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- Authors
- Feasey, N. A., Banada, P. P., Howson, W., Sloan, D. J., Mdolo, A., Boehme, C., Chipungu, G. A., Allain, T. J., Heyderman, R. S., Corbett, E. L., & Alland, D.
- Affiliations
- University of Liverpool (GB)
- Rutgers New Jersey Medical School (US)
- Liverpool School of Tropical Medicine (GB)
- University of Malawi (MW)
- FIND (CH)
- Corresponding author
- Feasey, Nicholas A.
- ORCID
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2013-07
- Volume
- 51
- Issue
- 7
- Pages
- 2311-2316
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC3697654
- OpenAlex
- W2164897338
- Cited by
- 57
- References
- 26
- Citations by year
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- FWCI
- 4.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Microbiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- St Andrews Research Repository (St Andrews Research Repository) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Wellcome Trust (101113, 100890, 091769, 084679/Z/08/Z)
- 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, tuberculosis diagnosis, HIV infection, sensitivity and specificity, mortality prediction, prognosis, pulmonary tuberculosis, sputum examination, treatment initiation
- MeSH terms
- Adult, Bacteriological Techniques, Female, Humans, Malawi, Male, Middle Aged, Mycobacterium tuberculosis, Predictive Value of Tests, Prognosis, Prospective Studies, Sensitivity and Specificity, Tuberculosis, Cohort Studies, HIV Infections, Survival Analysis, Bacteremia, Molecular Diagnostic Techniques
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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