The diagnostic performance of Xpert MTB/RIF Ultra on Pericardial, Pleural and Ascitic cohort study fluids for diagnosis of extra-pulmonary Tuberculosis at a referral hospital in Malawi

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Martin Kamponda, F. Bickton, Donnie Mategula, M. Nliwasa, Benno Kreuels, J. Kumwenda
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引用次数: 0

Abstract

BackgroundExtra-pulmonary tuberculosis (EPTB) accounts for 15% of the 1.4 million patients with TB notified in 2019. EPTB carries a high risk of mortality and so early diagnosis and treatment are important to reduce this risk. Diagnosis of EPTB in low- and middle-income countries is challenging. This study investigated the diagnostic performance of Xpert MTB Ultra for the diagnosis of EPTB (pericardial, pleural, and ascitic fluid) in adults at a referral hospital in Malawi. MethodsAdults with suspected extra-pulmonary TB were screened for evidence of extra-pulmonary fluid and tested for TB using Xpert MTB Ultra, mycobacterial culture, and a Focused Abdominal Sonography in HIV-associated TB (FASH scan). The diagnostic performance of the Xpert MTB Ultra was compared to mycobacterial culture and a composite reference standard defined as a positive FASH scan or a positive mycobacterial culture or a clinical TB diagnosis (constitutional symptoms not otherwise explained with response to empirical TB treatment).ResultsThere were 174 patients recruited: 99/174 (57%) pleural, 70/174 (40%) ascitic and 5/174 (3%) pericardial. Overall, 10/174 (6%) had bacteriologically confirmed TB and 30/174 (17%) were started on TB treatment based on a positive FASH scan or a clinical TB diagnosis. The sensitivity and specificity of Xpert ultra compared to culture was 83% (95%CI:36%-100%) and 98% (95%CI:94%-99%), respectively. Compared to the composite reference standard, the sensitivity of Xpert Ultra was 17% (95%CI:7%-34%) and specificity was 98% (95%CI:94%-100%). ConclusionXpert MTB Ultra provides good diagnostic performance on pleural, pericardial and ascitic fluid with reference to mycobacterial culture. Improved EPTB diagnostic tests are required to improve patient outcomes. We recommend larger multi-centre studies to corroborate our findings.
马拉维一家转诊医院 Xpert MTB/RIF Ultra 对心包、胸膜和腹水队列研究液体的诊断性能,用于诊断肺外结核病
背景在 2019 年通报的 140 万肺结核患者中,肺外结核(EPTB)占 15%。EPTB 有很高的死亡风险,因此早期诊断和治疗对降低这一风险非常重要。在中低收入国家,EPTB 的诊断具有挑战性。本研究调查了马拉维一家转诊医院 Xpert MTB Ultra 对成人 EPTB(心包液、胸腔积液和腹水)诊断的性能。方法对疑似肺外结核病的成人进行肺外积液证据筛查,并使用 Xpert MTB Ultra、分枝杆菌培养和 HIV 相关结核病腹部聚焦超声扫描(FASH 扫描)进行结核病检测。将 Xpert MTB Ultra 的诊断性能与分枝杆菌培养和综合参考标准进行了比较,综合参考标准的定义是 FASH 扫描阳性、分枝杆菌培养阳性或临床肺结核诊断(对经验性肺结核治疗无效的全身症状):99/174(57%)例为胸膜结核,70/174(40%)例为腹水结核,5/174(3%)例为心包结核。总体而言,10/174(6%)的患者经细菌学确诊为肺结核,30/174(17%)的患者根据 FASH 扫描阳性或临床肺结核诊断开始接受肺结核治疗。与培养结果相比,Xpert ultra 的灵敏度和特异性分别为 83% (95%CI:36%-100%) 和 98% (95%CI:94%-99%)。与综合参考标准相比,Xpert Ultra 的灵敏度为 17% (95%CI:7%-34%),特异性为 98% (95%CI:94%-100%)。结论 Xpert MTB Ultra 对胸膜液、心包液和腹水的诊断效果比分枝杆菌培养更好。需要改进 EPTB 诊断测试,以改善患者的治疗效果。我们建议开展更大规模的多中心研究来证实我们的发现。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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