Cited by 78Tuberculosis Research and EpidemiologyDiagnosis and treatment of tuberculosisInfectious Diseases and Tuberculosis

Evaluation of Xpert MTB/RIF assay performance in diagnosing extrapulmonary tuberculosis among adults in a tertiary care centre in India

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Sharma, Surendra K., Kohli, Mikashmi, Chaubey, Jigyasa, Yadav, Raj Narayan, Sharma, Rohini, Singh, Binit Kumar, Sreenivas, Vishnubhatla, Sharma, Abhishek +5 more·2014·European Respiratory Journal

Abstract

To the Editor: According to the World Health Organization Global Tuberculosis Report from 2013, there were 8.6 million incident tuberculosis (TB) cases globally and India alone contributed 26% to this global scenario [1]. Of the five countries with the largest number of TB incident cases in 2012, India tops the list [1]. Epidemiological data suggest that extrapulmonary TB (EPTB) constitutes about 15–20% of all TB cases, but among HIV-TB co-infection it accounts for 50% of the cases [2]. Out of 1 183 373 new TB cases notified globally, 234 029 (20%) were reported to be cases of EPTB [1]. Difficulty in sampling from the extrapulmonary sites and the paucibacillary nature of the specimens make EPTB a diagnostic challenge. Dependency on smear microscopy in these samples may lead to higher false negative rates due to the low sensitivity of this technique. Mycobacterium tuberculosis (MTB) culture is quite a protracted technique, requiring well-trained laboratory personnel, and delay in diagnosis can cause more harm as the treatment is often started empirically. Rapid nucleic acid amplification tests are emerging extensively to provide better yield for rapid diagnosis of TB. The Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is an automated, hemi-nested real-time PCR for detecting MTB complex and rifampin (RIF) resistance, which was initially evaluated for pulmonary specimens in large studies [3–5]. The present communication reports the performance of Xpert MTB/RIF in EPTB samples, with a large sample size from a single centre in a country with a high TB burden. All EPTB samples from indoor as well as outdoor facilities of the All India Institute of Medical Sciences (AIIMS) hospital, New Delhi, India, were received in the Tuberculosis Laboratory (accredited Intermediate Reference Laboratory …

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Crossref · 10.1183/09031936.00059014

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  • In urine, Xpert MTB/RIF sensitivity against a composite reference standard in Sharma 2014 was 33% (1 to 91).

    “In urine, Xpert MTB/RIF sensitivity and specificity against a composite reference standard were 33% (1 to 91) and 100% (92 to 100) (Sharma 2014), and 41% (33 to 50 ) and 100% (99 to 100) (Chen 2019) (2 studies; 463 participants); Figure 15.”

    From Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults (2021) · cites this paper as Sharma 2014

    Table 1 (page not available in our copy) reports 33% urine sensitivity against the composite reference standard when two parameters are positive, but gives a 95% confidence interval of 6.1–79.2%, not 1–91%. Under the one-parameter CRS definition, it reports 9% sensitivity. The point estimate is supported, but the cited interval and unspecified CRS definition are not. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • In urine, Xpert MTB/RIF specificity against a composite reference standard in Sharma 2014 was 100% (92 to 100).

    “In urine, Xpert MTB/RIF sensitivity and specificity against a composite reference standard were 33% (1 to 91) and 100% (92 to 100) (Sharma 2014), and 41% (33 to 50 ) and 100% (99 to 100) (Chen 2019) (2 studies; 463 participants); Figure 15.”

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Cites

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Research works printed but not linked: 9

  1. Centers for Disease Control and Prevention. Global Routine Vaccination Coverage, 2011. MMWR Morb Mortal Wkly Rep 2012; 61: 883-885.
  2. Abubakar I, Pimpin L, Ariti C, et al. Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Gue ´rin vaccination against tuberculosis. Health Technol Assess 2013; 17: 1-372.
  3. Faurholt-Jepsen D, Range N, PrayGod G, et al. BCG protects against tuberculosis irrespective of HIV status: a matched case-control study in Mwanza, Tanzania. Thorax 2012; 68: 288-289.
  4. Basu Roy R, Whittaker E, Kampmann B. Current understanding of the immune response to tuberculosis in children. Curr Opin Infect Dis 2012; 25: 250-257.
  5. Eisenhut M, Paranjothy S, Abubakar I, et al. BCG vaccination reduces risk of infection with Mycobacterium tuberculosis as detected by gamma interferon release assay. Vaccine 2009; 27: 6116-6120.
  6. Abubakar I, Matthews T, Harmer D, et al. Assessing the effect of foreign travel and protection by BCG vaccination on the spread of tuberculosis in a low incidence country, United Kingdom, October 2008 to December 2009. Euro Surveill 2011; 16: 19526.
  7. Diel R, Loytved G, Nienhaus A, et al. Neue Empfehlungen fur die Umgebungsuntersuchungen bei Tuberkulose. [New recommendations for contact tracing in tuberculosis.]. Pneumologie 2011; 65: 359-378.
  8. Haussinger K, Ballin A, Becker HD, et al. Empfehlungen zur Sicherung der Qualitat in der Bronchoskopie. [Recommendations for quality standards in bronchoscopy]. Pneumologie 2004; 58: 344-356.
  9. Porcel JM, Palma R, Valde ´s L, et al. Xpert1 MTB/RIF in pleural fluid for the diagnosis of tuberculosis. Int J Tuberc Lung Dis 2013; 17: 1217-1219.

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Authors
Sharma, S. K., Kohli, M., Chaubey, J., Yadav, R. N., Sharma, R., Singh, B. K., Sreenivas, V., Sharma, A., Bhatia, R., Jain, D., Seenu, V., Dhar, A., & Soneja, M.
Affiliations
All India Institute of Medical Sciences (IN)
Venue
European Respiratory Journal
Published
2014-07-25
Volume
44
Issue
4
Pages
1090-1093
ISSN
  • 0903-1936 (ISSN-L)
  • 1399-3003
OpenAlex
W2046146238
Cited by
78
References
16
Citations by year
2026: 6 · 2025: 5 · 2024: 3 · 2023: 9 · 2022: 9 · 2021: 12 · 2020: 10 · 2019: 2 · 2018: 8 · 2017: 5 · 2016: 5 · 2015: 4
FWCI
3.27
Type
journal article
Language
en
Open access
Locations
  • European Respiratory Journal (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Bill and Melinda Gates Foundation
  • Ministry of Health and Family Welfare
  • All-India Institute of Medical Sciences
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Keywords
Xpert MTB/RIF, extrapulmonary tuberculosis, Mycobacterium tuberculosis detection, rifampicin resistance, nucleic acid amplification tests, diagnostic accuracy, rapid molecular diagnostics, India
MeSH terms
Adult, Antibiotics, Antitubercular, Humans, India, Mycobacterium tuberculosis, Rifampin, Tuberculosis, Drug Resistance, Bacterial, Real-Time Polymerase Chain Reaction, Tertiary Care Centers

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