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Background: Tuberculosis (TB) is one of the significant health concerns in Egypt, necessitating rapid, affordable, and accurate diagnosis to aid in its control. This study presents data collected over five years (2017-2021) to explore different diagnostic TB methods in our lab. Methods: A total of 33700 non-repetitive samples were subjected to different diagnostic methods; 30000 were stained by Ziehl–Neelsen (ZN), of which 2819 were cultured on Löwenstein-Janssen (LJ) media, and 456 were analyzed by GeneXpert; 3700 samples were tested by interferon-gamma release assay (IGRA) Quantiferon. Moreover, 3650 patients underwent the tuberculin skin test (TST). Results: GeneXpert displayed the highest positivity (23.9%), while ZN smear microscopy was the lowest (4.8%). The detection capability between pulmonary and extrapulmonary samples was not statistically significant using LJ culture but significant using GeneXpert MTB/RIF. Rifampicin resistance was 17.4% among the GeneXpert Mycobacterium tuberculosis (MTB)-positive samples. Conclusions: GeneXpert MTB/RIF assay is a user-friendly, rapid, and efficient method for identifying pulmonary and extrapulmonary TB with the simultaneous detection of rifampicin-resistant strains. However, culture and smear microscopy remain the most dominant diagnostic methods in developing countries due to their low cost and relatively acceptable specificity. [ABSTRACT FROM AUTHOR]

Latar belakang. Diagnosis tuberkulosis (TB) paru pada anak sering kali sulit dilakukan. Sifat pausibasiler dari TB pada anak kerap seringkali menyulitkan konfirmasi bakteriologis. Oleh karena itu, rontgen toraks menjadi modalitas penting ketika didapatkan hasil negatif pada pulasan bakteri. Tujuan. Penelitian ini bertujuan untuk melihat tingkat kesesuaian antara hasil rontgen toraks dan GeneXpert MTB/RIF pada kasus TB paru pada anak. Metode. Penelitian ini merupakan studi potong lintang yang dilakukan dengan menelusuri rekam medis pasien anak dengan dugaan TB paru di Rumah Sakit dr. Mohammad Hoesin Palembang pada tahun 2018-2020. Subjek penelitian dikelompokkan sebagai terdeteksi atau tidak terdeteksi TB berdasarkan hasil GeneXpert MTB/RIF dan sugestif atau non-sugestif TB berdasarkan rontgen toraks. Data kemudian dianalisis menggunakan uji Cohen’s Kappa (k). Hasil. Terdapat 207 kasus dugaan TB paru pada anak dengan sebagian besar subjek berusia 0-

Abstract Extra-pulmonary TB (EPTB) is difficult to diagnose due to paucibacillary nature of disease. Current study evaluated accuracy of Truenat MTB and MTB-Rif Dx (TN), for detection of Mycobacterium tuberculosis and resistance to rifampicin. Samples were collected from 2103 treatment naive adults with presumptive EPTB, and tested by smear microscopy, liquid culture (LC) (MGIT-960) and GeneXpert MTB/RIF (GX) (Microbiological Reference Standards, MRS). TN results were compared to MRS and Composite Reference Standards (CRS, Microbiology, histopathology, radiology, clinical features prompting decision to treat, response to treatment). CRS grouped patients into 551 confirmed, 1096 unconfirmed, and 409 as unlikely TB. TN sensitivity and specificity was 73.7% and 90.4% against GX. Against LC, Overall sensitivity of GX was 67.6%, while that of TN was 62.3%. Highest sensitivity by TN was observed in pus samples (89%) and highest specificity (92%) in CSF samples, similar to GX. TN sensitivity was better in fluid and biopsy samples and slightly inferior for lymph node aspirates compared to GX. TN sensitivity for RIF resistance detection was slightly superior to GX. TN and GX results were further compared to Clinical Reference Standards. TN detected 170 TB patients initiated on treatment missed by GX, while GX detected 113 such patients missed by TN. Of 124 samples with RIF resistance discordance between GX and TN, GX reported 103/124 as sensitive, 3/124 as indeterminate and 18 as resistant (13/18 samples had low/very low DNA load) while TN reported RIF resistance indeterminate in 103/111 low/very low DNA load samples. Due to paucibacillary nature of EPTB samples, culture yield was poor and phenotypic drug susceptibility testing failed to resolve the discordance. The study establishes TN at par with GX and can be utilized for quick and accurate diagnosis of EPTB.

Abstract Introduction Tuberculosis is a global health problem that causes 1. 4 million deaths every year. It has been estimated that sputum smear-negative diagnosis but culture-positive pulmonary TB diagnosis contribute to 12.6% of pulmonary TB transmission. TB diagnosis by smear microscopy smear has a minimum detection limit (LOD) of 5,000 to 10,000 bacilli per milliliter (CFU/ml) of sputum result in missed cases and false positives. However, GeneXpert technology, with a LOD of 131–250 CFU/ml in sputum samples and its implementation is believe to facilitate early detection TB and drug-resistant TB case. Since 2013, Ghana health Service (GHS) introduce GeneXpert MTB/RIF diagnostic in all regional hospitals in Ghana, however no assessment of performance between microscopy and GeneXpert TB diagnosis cross the health facilities has been reported. The study compared the results of routine diagnoses of TB by microscopy and Xpert MTB from 2016 to 2020 at the Cape Coast Teaching Hospital (CCTH). Methods The study compared routine microscopic and GeneXpert TB diagnosis results at the Cape Coast Teaching Hospital (CCTH) from 2016 to 2020 retrospectively. Briefly, sputum specimens were collected into 20 mL sterile screw-capped containers for each case of suspected TB infection and processed within 24 h. The samples were decontaminated using the NALC-NaOH method with the final NaOH concentration of 1%. The supernatants were discarded after the centrifuge and the remaining pellets dissolved in 1–1.5 ml of phosphate buffer saline (PBS) and used for diagnosis. A fixed smears were Ziehl-Neelsen acid-fast stain and observed under microscope and the remainings were used for GeneXpert MTB/RIF diagnosis. The data were analyze using GraphPad Prism. Results 50.11% (48.48–51.38%) were females with an odd ratio (95% CI) of 1.004 (0.944–1.069) more likely to report to the TB clinic for suspected TB diagnosis. The smear-positive cases for the first sputum were 6.6% (5.98–7.25%), and the second sputum was 6.07% (5.45–6.73%). The Xpert MTB-RIF diagnosis detected 2.93% (10/341) (1.42–5.33%) in the first and 5.44% (16/294) (3.14–8.69%) in the second smear-negative TB samples. The prevalence of Xpert MTB-RIF across smear positive showed that males had 56.87% (178/313) and 56.15% (137/244) and females had 43.13% (135/313) and 43.85% (107/244) for the first and second sputum. Also, false negative smears were 0.18% (10/5607) for smear 1 and 0.31% (16/5126) for smear 2. Conclusion In conclusion, the study highlights the higher sensitivity of the GeneXpert assay compared to traditional smear microscopy for detecting MTB. The GeneXpert assay identified 10 and 16 positive MTB from smear 1 and smear 2 samples which were microscopic negative.

Extra-pulmonary TB (EPTB) is difficult to diagnose due to paucibacillary nature of disease. Current study evaluated accuracy of Truenat MTB and MTB-Rif Dx (TN), for detection of Mycobacterium tuberculosis and resistance to rifampicin. Samples were collected from 2103 treatment naive adults with presumptive EPTB, and tested by smear microscopy, liquid culture (LC) (MGIT-960) and GeneXpert MTB/RIF (GX) (Microbiological Reference Standards, MRS). TN results were compared to MRS and Composite Reference Standards (CRS, Microbiology, histopathology, radiology, clinical features prompting decision to treat, response to treatment). CRS grouped patients into 551 confirmed, 1096 unconfirmed, and 409 as unlikely TB. TN sensitivity and specificity was 73.7% and 90.4% against GX. Against LC, Overall sensitivity of GX was 67.6%, while that of TN was 62.3%. Highest sensitivity by TN was observed in pus samples (89%) and highest specificity (92%) in CSF samples, similar to GX. TN sensitivity was better in fluid and biopsy samples and slightly inferior for lymph node aspirates compared to GX. TN sensitivity for RIF resistance detection was slightly superior to GX. TN and GX results were further compared to Clinical Reference Standards. TN detected 170 TB patients initiated on treatment missed by GX, while GX detected 113 such patients missed by TN. Of 124 samples with RIF resistance discordance between GX and TN, GX reported 103/124 as sensitive, 3/124 as indeterminate and 18 as resistant (13/18 samples had low/very low DNA load) while TN reported RIF resistance indeterminate in 103/111 low/very low DNA load samples. Due to paucibacillary nature of EPTB samples, culture yield was poor and phenotypic drug susceptibility testing failed to resolve the discordance. The study establishes TN at par with GX and can be utilized for quick and accurate diagnosis of EPTB. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is a global health problem that causes 1. 4 million deaths every year. It has been estimated that sputum smear-negative diagnosis but culture-positive pulmonary TB diagnosis contribute to 12.6% of pulmonary TB transmission. TB diagnosis by smear microscopy smear has a minimum detection limit (LOD) of 5,000 to 10,000 bacilli per milliliter (CFU/ml) of sputum result in missed cases and false positives. However, GeneXpert technology, with a LOD of 131–250 CFU/ml in sputum samples and its implementation is believe to facilitate early detection TB and drug-resistant TB case. Since 2013, Ghana health Service (GHS) introduce GeneXpert MTB/RIF diagnostic in all regional hospitals in Ghana, however no assessment of performance between microscopy and GeneXpert TB diagnosis cross the health facilities has been reported. The study compared the results of routine diagnoses of TB by microscopy and Xpert MTB from 2016 to 2020 at the Cape Coast Teaching Hospital (CCTH). Methods: The study compared routine microscopic and GeneXpert TB diagnosis results at the Cape Coast Teaching Hospital (CCTH) from 2016 to 2020 retrospectively. Briefly, sputum specimens were collected into 20 mL sterile screw-capped containers for each case of suspected TB infection and processed within 24 h. The samples were decontaminated using the NALC-NaOH method with the final NaOH concentration of 1%. The supernatants were discarded after the centrifuge and the remaining pellets dissolved in 1–1.5 ml of phosphate buffer saline (PBS) and used for diagnosis. A fixed smears were Ziehl-Neelsen acid-fast stain and observed under microscope and the remainings were used for GeneXpert MTB/RIF diagnosis. The data were analyze using GraphPad Prism. Results: 50.11% (48.48–51.38%) were females with an odd ratio (95% CI) of 1.004 (0.944–1.069) more likely to report to the TB clinic for suspected TB diagnosis. The smear-positive cases for the first sputum were 6.6% (5.98–7.25%), and the second sputum was 6.07% (5.45–6.73%). The Xpert MTB-RIF diagnosis detected 2.93% (10/341) (1.42–5.33%) in the first and 5.44% (16/294) (3.14–8.69%) in the second smear-negative TB samples. The prevalence of Xpert MTB-RIF across smear positive showed that males had 56.87% (178/313) and 56.15% (137/244) and females had 43.13% (135/313) and 43.85% (107/244) for the first and second sputum. Also, false negative smears were 0.18% (10/5607) for smear 1 and 0.31% (16/5126) for smear 2. Conclusion: In conclusion, the study highlights the higher sensitivity of the GeneXpert assay compared to traditional smear microscopy for detecting MTB. The GeneXpert assay identified 10 and 16 positive MTB from smear 1 and smear 2 samples which were microscopic negative. [ABSTRACT FROM AUTHOR]

Background: Sputum examination is the gold standard for the diagnosis of pulmonary tuberculosis. However, individuals particularly children, the aged, and immuno-compromised may not expectorate sputum due to some underlying conditions. Moreover, sputum produces infectious aerosols which exposes both the patients and care giver. It is also difficult to standardize sputum specimen for Mycobacterium tuberculosis. Therefore, the present study considered alternative specimen for pulmonary tuberculosis. Aim: To identify Mycobacterium tuberculosis in tongue swab. Methods: This was a cross-sectional laboratory-based study carried out in July-December 2022 on 384 tuberculosis patients attending health facilities in Karu, North central Nigeria. Using a multistage sampling technique, participants were added one at a time until the required sample size was gotten and analyzed via GeneXpert MTB/RIF. Performance of the tongue swab was compared to the combined reference standard of sputum XPERT. Results: The tongue swab XPERT ultra had a sensitivity of 78%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 97.4% relative to a sputum XPERT ultra reference standard. There were positive associations between the socio-demographic variables (age group, sex, family size, family type, marital status, religion, educational status, and occupation) and Mycobacterium tuberculosis infection. However, only the participant’s educational status (p=0.027) and occupation (p=0.05) had statistically significant difference. Conclusion: Tongue swab is an alternate specimen for sputum-based molecular diagnosis for Mycobacterium tuberculosis. The procedure is less invasive, easier, and non-aerosol producing efficient alternate approach for pulmonary tuberculosis.

Background: Sputum examination is the gold standard for the diagnosis of pulmonary tuberculosis. However, individuals particularly children, the aged, and immunocompromised may not expectorate sputum due to some underlying conditions. Moreover, sputum produces infectious aerosols which exposes both the patients and care giver. It is also difficult to standardize sputum specimen for Mycobacterium tuberculosis. Therefore, the present study considered alternative specimen for pulmonary tuberculosis. Aim: To identify Mycobacterium tuberculosis in tongue swab. Methods: This was a cross-sectional laboratory-based study carried out in July-December 2022 on 384 tuberculosis patients attending health facilities in Karu, North central Nigeria. Using a multistage sampling technique, participants were added one at a time until the required sample size was gotten and analyzed via GeneXpert MTB/RIF. Performance of the tongue swab was compared to the combined reference standard of sputum XPERT. Results: The tongue swab XPERT ultra had a sensitivity of 78%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 97.4% relative to a sputum XPERT ultra reference standard. There were positive associations between the socio-demographic variables (age group, sex, family size, family type, marital status, religion, educational status, and occupation) and Mycobacterium tuberculosis infection. However, only the participant's educational status (p=0.027) and occupation (p=0.05) had statistically significant difference. Conclusion: Tongue swab is an alternate specimen for sputum-based molecular diagnosis for Mycobacterium tuberculosis. The procedure is less invasive, easier, and non-aerosol producing efficient alternate approach for pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to effectively evaluate the diagnostic performance of the EasyNAT Mycobacterium tuberculosis complex (MTC) assay for tuberculosis (TB) detection from sputum. Methods: The retrospectively analyzed data was collected from September 1, 2021, to November 1, 2023, in our hospital. Results: Forty EasyNAT-positive sputum specimens were simultaneously detected using the GeneXpert MTB/ rifampicin (RIF) assay. The concordance rate between the EasyNAT and GeneXpert MTB/RIF assays was 100%. Conclusions: Because of the complexity of detecting RIF resistance data information, the rapid EasyNAT system used in conjunction with GeneXpert might be a better choice for the detection of TB in hospitals. [ABSTRACT FROM AUTHOR]

Abstract Background GeneXpert MTB/RIF (Xpert) assay was applied widely to detect Mycobacterium tuberculosis (MTB) and rifampicin resistance. Methods Retrospectively investigated the association among treatment histories, phenotypic drug susceptibility testing (pDST) results, and clinical outcomes of patients infected with probe A absent mutation isolate confirmed by Xpert. Results 63 patients with only probe A absent mutation and 40 with additional pDST results were analyzed. 24 (60.0%) patients had molecular-phenotypic discordant rifampicin (RIF) susceptibility testing results, including 12 (12/13, 92.3%) new tuberculosis (TB) patients and 12 (12/27, 44.4%) retreated ones. 28 (28/39, 71.8%) retreated patients received first-line treatment regime within two years with failed outcomes. New patients had better treatment outcomes than retreated ones (successful: 83.3% VS. 53.8%; P value = 0.02). The clinical results of RIF-susceptible TB confirmed by pDST were not better than RIF-resistant TB (successful: 62.5% VS. 50.0%; P value = 0.43). INH-resistant TB and INH-susceptible TB had similar treatment outcomes too (successful: 61.5% VS. 50.0%; P value = 0.48). 11 (11/12, 91.7%) new patients treated with the short treatment regimen (STR) had successful outcomes. Conclusions More than half of mono probe A absent isolates had RIF molecular-phenotypic discordance results, especially in new patients. Probe A mutations were significantly associated with unsuccessful clinical outcomes, whether the pDST results were RIF susceptible or not. STR was the best choice for new patients. Trial registration retrospectively registered in Wuhan Jinyintan Hospital (No. 2021-KY-16).

Objective: To identify concordance and discordance between GeneXpert MTB/RIF assay and gold standard bacteriologic culture for the diagnosis of Mycobacterium tuberculosis (MTB) in Extra-Pulmonary tuberculosis (EPTB) specimens in our region. Methods: This is a retrospective cross-sectional study conducted at the Indus Hospital and Health Network. Data from 1st January, 2020 to 31st December, 2021 was analyzed. A total of 1499 EPTB specimens were included for which GeneXpert was requested along with acid-fast bacteria (AFB) culture from the same specimen. Specimens were processed according to specimen type following standard operating procedures of the laboratory. Fluorescent staining was performed on all specimens along with bacteriologic culture. The GeneXpert MTB/RIF assay was carried out in exact accordance with the manufacturer's instructions. Results: Out of 1499 EPTB specimens, 1370 (91.39%) specimens exhibited concordance between GeneXpert and conventional culture method, while 129 (8.60%) specimens showed discordance. GeneXpert exhibited sensitivity and specificity of 69.4% and 94.3% respectively in comparison to culture. Conclusion: GeneXpert sensitivity for the diagnosis of EPTB varied with the site involved. Lower sensitivity was observed in ascitic and pleural fluids as compared to higher sensitivity observed among urine samples and pus aspirates. However, given the quick turnaround time and ease of use, it is a helpful tool in the diagnosis of EPTB when utilized in the appropriate clinical context. Caution is advised while interpreting negative GeneXpert results in endemic settings and should be interpreted along with other supporting clinical and diagnostic features. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between the availability of GeneXpert®MTB/RIF in municipalities and the proportion of people who have access to this diagnostic technology for tuberculosis (TB), as well as the resistance detected by the surveillance system in Brazil. Methods: We analysed 4998 Brazilian municipalities that reported 432,937 new TB cases between 2015 and 2020. We compared municipalities with and without the availability of GeneXpert®MTB/RIF regarding the effective access to GeneXpert®MTB/RIF diagnosis and the prevalence of detected resistance. Results: Municipalities with at least one GeneXpert®MTB/RIF system had three times (95% CI 2.9–3.0) the access to diagnostic tests and 80.4% (95% CI 70.6%–90.2%) higher detection of resistance, compared with municipalities without this technology. We estimated that there have been 1890 cases of undetected resistance during this period in the country. Conclusions: The availability of GeneXpert®MTB/RIF system in the municipality increased the sensitivity of the surveillance for detecting TB resistance. Public Health Implications: It is a priority to strengthen laboratory networks and narrow the gap in access to rapid diagnosis in remote areas to improve the detection and control of drug‐resistant tuberculosis. [ABSTRACT FROM AUTHOR]

Copyright of Casos & Revisiones de Salud is the property of Victor Manuel Mendoza Nunez, Universidad Nacional Autonoma de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The Metagenomics next-generation sequencing (mNGS) and GeneXpert MTB/RIF assay (Xpert) exhibited a sensitivity for tuberculosis (TB) diagnostic performance. Research that directly compared the clinical performance of ddPCR analysis, mNGS, and Xpert in mycobacterium tuberculosis complex (MTB) infection has not been conducted. Methods: The study aimed to evaluate the diagnostic performance of ddPCR compared to mNGS and Xpert for the detection of MTB in multiple types of clinical samples. The final clinical diagnosis was used as the reference standard. Results: Out of 236 patients with suspected active TB infection, 217 underwent synchronous testing for tuberculosis using ddPCR, Xpert, and mNGS on direct clinical samples. During follow-up, 100 out of 217 participants were diagnosed with MTB infection. Compared to the clinical final diagnosis, ddPCR produced the highest sensitivity of 99% compared with mNGS (86%) and Xpert (64%) for all active MTB cases. Discussion: Twenty-two Xpert-negative samples were positive in mNGS tests, which confirmed the clinical diagnosis results from ddPCR and clinical manifestation, radiologic findings. Thirteen mNGS-negative samples were positive in ddPCR assays, which confirmed the clinical final diagnosis.ddPCR provides a higher sensitive compared to Xpert and mNGS for MTB diagnosis, as defined by the high concordance between ddPCR assay and clinical final diagnosis. [ABSTRACT FROM AUTHOR]

Background: GeneXpert MTB/RIF (Xpert) assay was applied widely to detect Mycobacterium tuberculosis (MTB) and rifampicin resistance. Methods: Retrospectively investigated the association among treatment histories, phenotypic drug susceptibility testing (pDST) results, and clinical outcomes of patients infected with probe A absent mutation isolate confirmed by Xpert. Results: 63 patients with only probe A absent mutation and 40 with additional pDST results were analyzed. 24 (60.0%) patients had molecular-phenotypic discordant rifampicin (RIF) susceptibility testing results, including 12 (12/13, 92.3%) new tuberculosis (TB) patients and 12 (12/27, 44.4%) retreated ones. 28 (28/39, 71.8%) retreated patients received first-line treatment regime within two years with failed outcomes. New patients had better treatment outcomes than retreated ones (successful: 83.3% VS. 53.8%; P value = 0.02). The clinical results of RIF-susceptible TB confirmed by pDST were not better than RIF-resistant TB (successful: 62.5% VS. 50.0%; P value = 0.43). INH-resistant TB and INH-susceptible TB had similar treatment outcomes too (successful: 61.5% VS. 50.0%; P value = 0.48). 11 (11/12, 91.7%) new patients treated with the short treatment regimen (STR) had successful outcomes. Conclusions: More than half of mono probe A absent isolates had RIF molecular-phenotypic discordance results, especially in new patients. Probe A mutations were significantly associated with unsuccessful clinical outcomes, whether the pDST results were RIF susceptible or not. STR was the best choice for new patients. Trial registration: retrospectively registered in Wuhan Jinyintan Hospital (No. 2021-KY-16). [ABSTRACT FROM AUTHOR]

This study seeks to describe the rollout and current state of South Africa's GeneXpert molecular diagnostic program for tuberculosis (TB). Xpert MTB/RIF was introduced in 2011 with a subsequent expansion to include extra-pulmonary and paediatric testing, followed by Xpert MTB/RIF Ultra in 2017. Through a centralised laboratory information system and the use of a standardised platform for more than a decade, over 23 million tests were analysed, describing the numbers tested, Mycobacterium tuberculosis complex detection, rifampin resistance, and the unsuccessful test rates. The stratification by province, specimen type, age, and sex identified significant heterogeneity across the program and highlighted testing gaps for men, low detection yield for paediatric pulmonary TB, and the effects of inadequate specimen quality on the detection rate. The insights gained from these data can aid in the monitoring of interventions in support of the national TB program beyond laboratory operational aspects. [ABSTRACT FROM AUTHOR]

This paper reported a case of tuberculous pericardial effusion which was confirmed by GeneXpert MTB/RIF (Mycobacterium tuberculosis rpoB gene and mutation detection). During the early stage of the diagnosis, the routine anti-infection was ineffective, the pathogenic bacteria was not founded in the case, and tumor or other causes were excluded. The clinical diagnosis was considered as tuberculous pericardial effusion, while multiple tests for acid-fast bacilli was negative. The patient’s pericardial effusion was used to perform GeneXpert MTB/RIF test, and positive (very low dose) result was obtained. Through anti-tuberculous treatment, the pericardial effusion of the patient decreased to a small amount and the symptoms improved significantly after 2 weeks. And 3 months later, the symptoms disappeared. The diagnosis and treatment of the patient suggested that multiple methods should be actively applied during the early stage of clinical diagnosing tuberculous pericardial effusion. Beside traditional acid-fast bacillus smear and mycobacterium culture, the adenosine deaminase (ADA) and GeneXpert MTB/RIFF tests for pericardial effusion and interferon-gamma release assay (IGRA) for blood should be considered.

Copyright of China Tropical Medicine is the property of China Tropical Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Although cardiac involvement is extremely rare in tuberculosis (TB), cardiac dysfunction is not uncommon. We have studied the prevalence of cardiac dysfunction in pulmonary TB with special emphasis on echocardiography, serum cortisol, and its correlation in cases with unstable cardiorespiratory parameters. Methods: A prospective observational and interventional study conducted in Pulmonary Medicine, MIMSR Medical College and Venkatesh Chest Hospital, Latur, India during July 2015 to December 2020, which included 800 cases of active pulmonary TB confirmed microscopically or with GeneXpert MTB/RIF, documented MTB genome in respiratory specimens’ sputum/induced sputum and bronchoscopy-guided bronchial wash, or bronchoalveolar lavage whenever necessary. Cases with known risk factors for cardiac disease and taking cardiac medicines and cases with pericardial effusion were excluded from study. Disproportionate tachycardia and tachypnea with or without shock and hypoxia were the key entry point criteria in this study. Chest radiograph, pulse oximetry, electrocardiography (ECG), sputum examination, cardiac enzyme studies (creatine phosphokinase MB [CPK-MB] and cardiac troponins), serum cortisol test, and echocardiography are done in all study cases during enrollment at 2 and 6 months of treatment with anti-TB medicines. Statistical analysis was carried out by chi-square test. Observations and analysis: Of the 800 cases with active pulmonary TB, cardiac dysfunction was documented in 26% cases, 44% were females, and 56% cases were older than 50 years. Echocardiographic abnormalities were documented such as global hypokinesia in 62% cases; depressed left ventricular systolic and diastolic function in 44 and 28% cases, respectively; dilated right atrium and right ventricle in 32% cases; and pulmonary hypertension in 6% cases. Serum cortisol level was significantly lower in cases with cardiac dysfunction (P < 0.00001). Hypoxia had significant association with right and left heart dysfunction (P < 0.00001). Cachexia, anemia, and hypoalbuminemia were documented to have significant association with cardiac dysfunction (P < 0.00001). Treatment outcome showed significant improvement in cardiac function (P < 0.00001). Coronary angiography did not show significant coronary artery lesions, and computed tomography (CT) pulmonary angiography did not show pulmonary embolism. Conclusion: Cardiac dysfunction in active pulmonary TB is underestimated and less evaluated routinely; disproportionate tachycardia and tachypnea with or without shock are clinical indicators to suspect early, especially in cases with risk factors such as advanced pulmonary TB on chest radiograph, cachexia with body mass index (BMI)

HM Adnan Hameed1– 4&ast;, Cuiting Fang1– 4&ast;, Zhiyong Liu,1– 3 Yanan Ju,1– 3 Xingli Han,1– 4 Yamin Gao,1– 4 Shuai Wang,1– 3,5 Gift Chiwala,1– 4 Yaoju Tan,6 Ping Guan,6 Jinxing Hu,6 Xiaoli Xiong,1– 3 Jiacong Peng,3,7 Yongping Lin,3,7 Muzammal Hussain,4 Nanshan Zhong,3,7,8 Dmitry A Maslov,9 Gregory M Cook,10,11 Jianxiong Liu,6 Tianyu Zhang1– 4 1State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health (GIBH), Chinese Academy of Sciences (CAS), Guangzhou, People’s Republic of China; 2China-New Zealand Joint Laboratory of Biomedicine and Health, Guangzhou Institutes of Biomedicine and Health (GIBH), Chinese Academy of Sciences (CAS), Guangzhou, People’s Republic of China; 3Guangdong-Hong Kong-Macau Joint Laboratory of Respiratory Infectious Diseases, Guangzhou, People’s Republic of China; 4University of Chinese Academy of Sciences (UCAS), Beijing, People’s Republic of China; 5National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Tuberculosis, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China; 6State Key Laboratory of Respiratory Disease, Guangzhou Chest Hospital, Guangzhou, People’s Republic of China; 7State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 8Guangzhou National Laboratory, Guangzhou, People’s Republic of China; 9Laboratory of Bacterial Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia; 10Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; 11Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand&ast;These authors contributed equally to this workCorrespondence: Tianyu Zhang, Guangzhou Institutes of Biomedicine and Health (GIBH), Chinese Academy of Sciences (CAS), Room A207, 190 Kaiyuan Ave, Science Park, Huangpu District, Guangzhou, 510530, People’s Republic of China, Tel +86-2032015270, Email zhang_tianyu@gibh.ac.cn Jianxiong Liu, Guangzhou Chest Hospital, 62 Hengzhigang Road, Yuexiu District, Guangzhou, People’s Republic of China, Tel +86-2083595977, Email ljxer64@qq.comObjective: Rifampicin (RIF)-resistance, a surrogate marker for multidrug-resistant tuberculosis (TB), is mediated by mutations in the rpoB gene. We aimed to investigate the prevalence of mutations pattern in the entire rpoB gene of Mycobacterium tuberculosis clinical isolates and their association with resistance level to RIF.Methods: Among 465 clinical isolates collected from the Guangzhou Chest Hospital, drug-susceptibility of 175 confirmed Mtb strains was performed via the proportion method and Bactec MGIT 960 system. GeneXpert MTB/RIF and sanger sequencing facilitated in genetic characterization, whereas the MICs of RIF were determined by Alamar blue assay.Results: We found 150/175 (85.71%) RIF-resistant strains (MIC: 4 to > 64 μg/mL) of which 57 were MDR and 81 pre-XDR TB. Genetic analysis identified 17 types of mutations 146/150 (97.33%) within RRDR (codons 426– 452) of rpoB, mainly at L430 (P), D435 (V, E, G, N), H445 (N, D, Y, R, L), S450 (L, F) and L452 (P). D435V 12/146 (8.2%), H445N 16/146 (10.9%), and S450L 70/146 (47.94%) were the most frequently encountered mutations. Mutations Q432K, M434V, and N437D are rarely identified in RRDR. Deletions at (1284– 1289 CCAGCT), (1295– 1303 AATTCATGG), and insertion at (1300– 1302 TTC) were detected within RRDR of three RIFR strains for the first time. We detected 47 types of mutations and insertions/deletions (indels) outside the RRDR. Four RIFR strains were detected with only novel mutations/indels outside the RRDR. Two of the four had (K274Q + C897 del + I491M) and (A286V + L494P), respectively. The other two had (G1687del + P454L) and (TT1835-6 ins + I491L) individually. Compared with phenotypic characterization, diagnostic sensitivities of GeneXpert MTB/RIF and sequencing analysis were 95.33% (143/150), and 100% (150/150) respectively.Conclusion: Our findings underscore the key role of RRDR mutations and the contribution of non-RRDR mutations in rapid molecular diagnosis of RIFR clinical isolates. Such insights will support early detection of disease and recommend the appropriate anti-TB regimens in high-burden settings.Keywords: rifampicin-resistance, Mycobacterium tuberculosis, rpoB, GeneXpert MTB/RIF, resistance-determining region

Objective: Tuberculosis diagnosis requires rapid, simple and highly sensitive methods. Clustered regularly interspaced short palindromic repeats (CRISPRs) and associated protein (Cas) systems are increasingly being used for clinical diagnostic applications, due to their high flexibility, sensitivity and specificity. We developed a sensitive Mycobacterium tuberculosis (MTB) complex polymerase chain reaction (PCR)-CRISPR/Cas13a detection method (CRISPR-MTB) and then evaluated its performance in detecting MTB in clinical specimens. Methods: The conserved MTB IS1081 sequence was used to design CRISPR-derived RNAs (crRNAs) and T7 promoter sequencing-containing PCR primers for use in the CRISPR-MTB assay, then assay performance was evaluated using 401 clinical specimens. Results: The CRISPR-MTB assay provided a low limit of detection of 1 target sequence copy/µL and excellent specificity. Furthermore, use of the assay to detect MTB in bronchoalveolar lavage fluid (BALF), sputum and pus samples provided superior sensitivity (261/268, 97.4%) as compared to sensitivities of acid-fast bacilli (130/268, 48.5%) and mycobacterial culture (192/268, 71.6%) assays, and comparable or greater sensitivity to that of GeneXpert MTB/RIF (260/268, 97.0%). Conclusion: The CRISPR-MTB assay, which provides excellent sensitivity and specificity for MTB detection in sputum, BALF and pus samples, is a viable alternative to conventional tests used to diagnose TB in resource-limited settings. [ABSTRACT FROM AUTHOR]

El rendimiento del ensayo GeneXpert MTB/RIF para el diagnóstico de la tuberculosis extrapulmonar (TBEP) no se ha investigado en Panamá. El objetivo del estudio fue evaluar la precisión diagnóstica del ensayo GeneXpert MTB/RIF para diversas muestras extrapulmonares en relación con el método de referencia: cultivo MGIT/LJ (Mycobacteria Growth Indicator Tube/Lowenstein-Jensen). Obtuvimos un total de 200 muestras clínicas y se analizaron para detectar TBEP mediante el ensayo GeneXpert MTB/RIF y métodos convencionales estándar (cultivo y frotis directo). La sensibilidad (S), la especificidad (E), el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) del ensayo Xpert MTB/RIF para TBEP fueron del del 66.6 %, 97.3 %, 66.6 y 97.3 %, respectivamente. Se encontró que el ensayo GeneXpert MTB/RIF tiene buena especificidad, pero su sensibilidad es variable y dependerá del tipo de muestra utilizada. Concluimos que el GeneXpert MTB/RIF representa una buena herramienta para el diagnóstico de TBEP, pero un resultado negativo, no descartará la enfermedad. Por lo tanto, no puede recomendarse para reemplazar las pruebas convencionales estándar para el diagnóstico de TBEP, sin embargo, su uso junto a las metodologías tradicionales mejora el diagnóstico.

Abstract Background Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. Control of TB is lingering by the lack of diagnostic tests that are simple, rapid, yet accurate. Thus, smear-negative pulmonary TB often misses the diagnosis. The study evaluated the performance of GeneXpert MTB/RIF assay for the detection of Mycobacterium tuberculosis (MTB). Methods The study was carried out from June to December 2016 in Nepal Tuberculosis Center, Bhaktapur, Nepal. A total of 173 sputum samples were collected and processed by microscopy [Auramine-O staining and Ziehl–Neelsen (ZN) staining], followed by GeneXpert MTB/RIF assay and culture in Lowenstein-Jensen (LJ) medium. Results Of 173 sputum samples, 162 (93.6%) were smear-negative. Of 162 smear-negative sputum samples, 35 (21.6%) were confirmed to have MTB by culture, and 31 (19.1%) by GeneXpert MTB/RIF assay. Of 31 GeneXpert-positive samples, 25 (80.6%) were susceptible, 4 (12.9%) were resistant, and 2 (6.45%) were intermediate to rifampicin. The sensitivity, specificity, positive predictive value, and negative predictive value of GeneXpert MTB/RIF assay for smear-negative sputum samples were 74.3%, 96.6%, 86.7%, and 92%, respectively. The GeneXpert MTB/RIF has a substantial diagnostic agreement of 90.91% with culture (Cohen’s Kappa coefficient = 0.73). Conclusion The diagnostic performance of GeneXpert MTB/RIF assay was almost on par with culture, and thus can be relied upon for MTB detection in smear-negative sputum samples.

Diagnosing peritoneal tuberculosis is challenging due to unspecific clinical manifestations, particularly in immunocompromised patients with HIV/AIDS and tuberculosis infections. An Indonesian man, 26-years-old, complained of mid-abdominal colic and constipation. The patient's present state exhibited symptoms of weakness and paleness, oral candidiasis, a bloated abdomen, palpable discomfort, and shifting dullness. The ascitic fluid analysis showed increased ADA (709 U/L), and detected Mycobacterium tuberculosis using GeneXpert MTB/RIF. Radiographic examination from abdominal x-ray and CT scan revealed a small bowel obstruction. He received intestinal decompression, pain control, intravenous fluid resuscitation, and correction of electrolyte imbalance for small bowel obstruction without any indication for surgical intervention. He also receive first-line ATD for 2 months during intensive phase and 4 months for continuous phase. After a period of 2 weeks following the ATD administration, the patient began taking ARV medication on a daily basis. He showed a good prognosis 6 months following. The diagnosis of peritoneal tuberculosis is challenging due to its unspecific manifestation and some cases are identified when complications such as small bowel obstruction appear. The ADA test and GenExpert MTB/RIF are useful instruments for promptly diagnosing tuberculosis. It is suggested to use ARV treatment in individuals with HIV/AIDS who have peritoneal tuberculosis, starting 2 weeks following ATD treatments. Peritoneal tuberculosis with small bowel obstruction and HIV/AIDS infection is a rare case in which early diagnosis and monitoring play an important role in successful treatment. • The challenge of peritoneal tuberculosis diagnosis was unspecific clinical manifestations. • Peritoneal tuberculosis can be supported by the ADA test in ascitic fluid. • GeneXpert MTB/RIF testing on ascitic fluid supports in early diagnosis of peritoneal tuberculosis. [ABSTRACT FROM AUTHOR]

This study seeks to describe the rollout and current state of South Africa’s GeneXpert molecular diagnostic program for tuberculosis (TB). Xpert MTB/RIF was introduced in 2011 with a subsequent expansion to include extra-pulmonary and paediatric testing, followed by Xpert MTB/RIF Ultra in 2017. Through a centralised laboratory information system and the use of a standardised platform for more than a decade, over 23 million tests were analysed, describing the numbers tested, Mycobacterium tuberculosis complex detection, rifampin resistance, and the unsuccessful test rates. The stratification by province, specimen type, age, and sex identified significant heterogeneity across the program and highlighted testing gaps for men, low detection yield for paediatric pulmonary TB, and the effects of inadequate specimen quality on the detection rate. The insights gained from these data can aid in the monitoring of interventions in support of the national TB program beyond laboratory operational aspects.

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Multidrug -resistant tuberculosis (MDRTB) is a serious threat to mankind. India has the highest number of MDRTB cases, although majority remain undiagnosed due to inadequate diagnostic infrastructure, leading to increased community transmission and mortality. This one-year observational retrospective study highlighted the effectiveness of the National Tuberculosis Elimination Program (NTEP) for prompt detection of drug-resistant TB by GeneXpert MTB/RIF assay and revealed its associated clinico-epidemiological factors. The overall detection rates of MTB and RRTB were 20.70 % and 20.86 % respectively. The pediatric population had 7.69 % rifampicin resistance, and HIV was strongly associated with the development of TB and RRTB (P < 0.01)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Cutaneous tuberculosis (CTB) is the rarest case of extrapulmonary TB comprising 2% of total cases. It’s often a challenge both clinically and diagnostically. 1) To determine prevalence, age & gender-wise distribution of CTB. 2) To assess various diagnostic, microbiological modalities for the diagnosis of CTB. 76 skin biopsy specimens from suspected CTB lesions were analysed using following methods – Acid-fast Bacilli (AFB) staining (Ziehl-Neelsen method), growth of mycobacteria in culture (Lowenstein-Jensen media), and Gene Xpert MTB/RIF, Histopathological (H&E staining). Of the 76 specimens, 44 were males and 32 were females. The most commonly affected age group was 40–59 years. Infections were least common in 0-19 years age group. AFB was not seen in any of the primary smears. 10 were confirmed as CTB by the recovery of Mycobacterium in solid culture. Of the 10 culture positives, 9 were confirmed as MTB, and 1 was found to be NTM. Staining of 10 culture positive specimens revealed acid fast, beaded rods. Detection of MTB by Gene Xpert gave positive result in 9 cases with all RIF sensitive. All 9 PCR confirmed cases were also culture positive, all 9 were slow growers with a minimum of 5 weeks required for growth on the LJ slant. PCR is the test of choice and should be performed on all specimens of suspected CTB. However when coupled with the “gold standard” culture method, the diagnostic accuracy improves. Also, further, culture helps in identification and isolation of NTM’s.

Pulmonary tuberculosis has a lot of clinical manifestations, and it complicates the diagnosis of tuberculosis in the general clinical practice. We studied the clinical manifestations of tuberculosis detected in the pulmonary department and compared them with the significancy of diagnostic methods.Material and methods. People with a verified diagnosis of lung tuberculosis (n = 109) were examined using the GeneXpert MTB/RIF method if Ziehl Nielsen bacterioscopy has negative results or if there was no effect of treatment for two weeks.Results. All patients had complaints of both intoxication and bronchitis as with pneumonia on admission. Infiltrative tuberculosis (57.1 %; n = 68), disseminated tuberculosis (16.8 %; n = 20) were most often diagnosed. We looked for correlations between dyspnea and the prevalence of the process (p = 0.24), dyspnea with temperature (p = 0.24), the presence of pain in the chest (p = 0.405), the results of immunodiagnostics and sputum examination (p = 0.133). We found out that there are no such correlations in tuberculosis. The term for diagnosing tuberculosis was 7.97 ± 3.9 days in the presence of cough with sputum and 9.04 ± 4.3 days in the case of dry cough. The term for diagnosing tuberculosis was 12.31 ± 4.9 days in patients without cough. Mycobacterium tuberculosis was detected using GeneXpert MTB/RIF molecular genetic methods with nonproductive cough in 84.5 % (60 people out of 71), while in the first days of hospitalization in 46.6 % of patients (28 people out of 60, p < 0.001).Conclusion. It was found that the period of hospitalization is little related to the characteristics of patients and depends on organizational measures to identify mycobacterium tuberculosis. It is recommended to immediately apply the GeneXpert MTB/RIF method to patients with mild tuberculosis.

Objective: To evaluate the clinical diagnostic value of positive acid-fast staining combined with negative GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease (NTM-PD). Methods: A total of 133 inpatients with confirmed NTM-PD were included consecutively between January 1, 2018 and December 31, 2019, at Tongji Hospital and Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, in Wuhan, China. One hundred patients with confirmed pulmonary tuberculosis (PTB) were randomly included as the control group. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of positive acid-fast staining combined with a negative GeneXpert MTB/RIF result were 51.13% (95% confidence interval (CI) 42.52–59.73%), 97.00% (95% CI 93.60–100.40%), 95.78% (95% CI 90.98–100.57%), and 59.88% (95% CI 52.25–67.51%), respectively. When subjects were limited to patients with positive acid-fast staining, the sensitivity of a negative GeneXpert MTB/RIF result was 88.31% (95% CI 80.97–95.65%). When acid-fast staining was conducted ≥3 times, the sensitivity of this combination diagnosis method increased to 61.67% (95% CI 49.00–74.33%). Conclusions: Positive acid-fast staining combined with a negative GeneXpert MTB/RIF result could be an effective and time-saving method for the diagnosis of NTM-PD.

Early diagnosis of tuberculosis continues to be a challenge for clinicians. The World Health Organization (WHO) guidelines recommend the application of GeneXpert MTB/RIF in extra-pulmonary tuberculosis (EPTB) diagnosis. This study aimed to test and compare the accuracy of the GeneXpert MTB/RIF assay to diagnose pulmonary tuberculosis (PTB) and EPTB, compared to bacterial culture and to composite reference standard (CRS). The GeneXpert assay diagnosed tuberculosis (TB) in 19.5 % of patients. With reference to bacterial culture, the sensitivity of this assay for detection of the pulmonary and extra-pulmonary specimens was perfect. For pulmonary specimens, on using CRS; the detected sensitivity and specificity of the GeneXpert assay were 78.3 % and 99.1 %, respectively. However, for extra-pulmonary specimens, the sensitivity and specificity of the GeneXpert assay were 37.1 % and 99 %, respectively. In the current study, the GeneXpert assay showed almost perfect agreement with the bacterial culture for TB diagnosis. The diagnostic accuracy of the GeneXpert assay was high in ruling in, but not in ruling out of EPTB.

To evaluate the performance of GeneXpert MTB/RIF (Xpert) for tuberculous meningitis (TBM) and to identify additional indicators to improve diagnostic accuracy. An accuracy study was conducted. During 2011-2019, 243 TBM with 140 non-TBM in three TB-designated facilities in China were enrolled. Microbiological evidence of M tuberculosis (Mtb) in CSF was used as the reference. Additional indicators were identified by Boosted-Classification and Regression Tree (CART), the improvement of diagnostic performance was evaluated by ROC. The diagnostic sensitivity of Xpert was 71.1 % for definite TBM, and 5.5 % for probable/possible TBM. The positive rate of Xpert was improved with cerebrospinal fluid (CSF) increasing volume and was associated with CSF color (yellow). The additional indicators obtained by CART were CSF lactate and glucose and increased the sensitivity to 96.1 % (definite TBM) and 84.6 % (probable/possible TBM). The diagnostic performance of Xpert was satisfactory in definite TBM and would significantly be improved by the additional use of CSF lactate and glucose. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. Control of TB is lingering by the lack of diagnostic tests that are simple, rapid, yet accurate. Thus, smear-negative pulmonary TB often misses the diagnosis. The study evaluated the performance of GeneXpert MTB/RIF assay for the detection of Mycobacterium tuberculosis (MTB).Methods: The study was carried out from June to December 2016 in Nepal Tuberculosis Center, Bhaktapur, Nepal. A total of 173 sputum samples were collected and processed by microscopy [Auramine-O staining and Ziehl-Neelsen (ZN) staining], followed by GeneXpert MTB/RIF assay and culture in Lowenstein-Jensen (LJ) medium.Results: Of 173 sputum samples, 162 (93.6%) were smear-negative. Of 162 smear-negative sputum samples, 35 (21.6%) were confirmed to have MTB by culture, and 31 (19.1%) by GeneXpert MTB/RIF assay. Of 31 GeneXpert-positive samples, 25 (80.6%) were susceptible, 4 (12.9%) were resistant, and 2 (6.45%) were intermediate to rifampicin. The sensitivity, specificity, positive predictive value, and negative predictive value of GeneXpert MTB/RIF assay for smear-negative sputum samples were 74.3%, 96.6%, 86.7%, and 92%, respectively. The GeneXpert MTB/RIF has a substantial diagnostic agreement of 90.91% with culture (Cohen's Kappa coefficient = 0.73).Conclusion: The diagnostic performance of GeneXpert MTB/RIF assay was almost on par with culture, and thus can be relied upon for MTB detection in smear-negative sputum samples. [ABSTRACT FROM AUTHOR]

The diagnosis of childhood tuberculosis remains a challenge worldwide. The GeneXpert MTB/RIF test, a rapid Mycobacteria tuberculosis diagnostic tool, was recommended for use in children. No pediatric studies of GeneXpert MTB/RIF assessing pulmonary tuberculosis within a hospital setting has been done in Indonesia. We evaluated the performance of the GeneXpert MTB/RIF test compared with sputum culture on Lowenstein-Jensen (LJ) for the diagnosis of childhood pulmonary tuberculosis. This study was conducted in pediatric respirology inpatient and outpatient Dr. Soetomo Hospital, a tertiary care facility in Surabaya between June and August 2015 with a cross-sectional design. We consecutively enrolled 27 children aged 3 months to 14 years who had history of close contact with adult tuberculosis patients and showed symptoms of pulmonary tuberculosis. Sputum collection was performed by induced sputum and three examination methods were performed (microscopic, GeneXpert MTB/RIF and sputum culture) simultaneously followed by a drug sensitivity test for specimens detected with MTB growth. The GeneXpert MTB/RIF test had a sensitivity of 100% (95% CI 100-100) and a specificity of 95% (95% CI 85-100). The positive predictive value for diagnosing pulmonary TB was 89% (95% CI 68-100), the negative predictive value was 100% (95% CI 100-100) and positive likelihood ratio was 20 (95% CI 2.82-128). The GeneXpert MTB/RIF test on one sputum sample rapidly and correctly identified all children with culture-confirmed pulmonary tuberculosis with high specificity. Similar results were obtained between GeneXpert MTB/RIF and sputum culture based on age groups and clinical manifestations. Rifampicin resistance were both detected in GeneXpert MTB/RIF and MTB sensitivity test

Spinal tuberculosis (TB), the most common form of musculoskeletal tuberculosis, is an infection-related disease globally, with paraplegia occurring in severe cases. Therefore, identification of spinal TB at an early stage is important for early intervention and eventual therapy. In this study, we conducted a prospective cohort study in routine clinical practice to investigate the diagnosis of different TB tests. A total of 519 patients were recruited based on the radiology of spinal TB. The diagnostic model was computed by regression analysis and was determined by receiver operating characteristic (ROC) curve analysis. Specificity, sensitivity, predictive value, likelihood ratio, and accuracy were also computed and compared. GeneXpert MTB/RIF showed a higher positive rate compared to that in the acid-fast bacilli smear and Mycobacterium culture. The results also showed that the Mycobacterium tuberculosis -specific antigen/phytohemagglutinin ratio in the T-SPOT assay had a good performance in the preoperative diagnosis and prediction of spinal TB. The diagnostic model based on the ratio of tuberculosis-specific antigen/phytohemagglutinin combined with GeneXpert MTB/RIF showed better efficiency for spinal TB diagnosis. In summary, the tuberculosis-specific antigen/phytohemagglutinin ratio combined with GeneXpert MTB/RIF could provide an early diagnosis of spinal TB. [ABSTRACT FROM AUTHOR]

Abstract Background The main advantage of GeneXpert MTB/RIF® (Xpert) molecular diagnostic technology is the rapid detection of M.tuberculosis DNA and mutations associated with rifampicin (RIF) resistance for timely initiation of appropriate treatment and, consequently, preventing further transmission of the disease. We assessed time to treatment initiation and treatment outcomes of RIF-resistant and RIF-susceptible TB patients diagnosed and treated in Vladimir TB Dispensary, Russia in 2012, before and after implementation of GeneXpert MTB/RIF® diagnostic technology. Methods All adult patients suspected of having TB during February–December 2012 underwent a clinical examination, chest x-ray, microscopy, culture, and phenotypic drug susceptibility testing (DST). Starting August 2012 Xpert diagnostic technology became available in the facility. We used logistic regression to compare treatment outcomes in pre-Xpert and post-Xpert periods. Kaplan-Meier curves and log-rank test were used to compare the time to treatment initiation between the groups. Results Of 402 patients screened for TB during February–December 2012, 338 were diagnosed with TB (280 RIF-susceptible, 58 RIF-resistant). RIF-resistant patients in the post-Xpert group started treatment with second-line drugs (SLD) earlier than those in pre-Xpert group (median 11 vs. 37 days, Log-rank p = 0.02). The hazard ratio for time to SLD treatment initiation was significantly higher in post-Xpert group (HR:2.06; 95%CI:1.09,3.89) compared to pre-Xpert group. Among the 53/58 RIF-resistant TB patients with available treatment outcome, 28 (53%) had successful outcomes (cured/completed treatment) including 15/26 (58%) in post-Xpert group versus 13/27 (48%) in pre-Xpert group. The observed difference, however, was not statistically significant (OR:0.69; 95%CI:0.23,2.06). Among RIF-susceptible TB cases time to treatment initiation was not significantly different between the groups (2 vs. 3 days, Log-rank p = 0.73). Of 252/280 RIF-susceptible TB cases with treatment outcome, 199 (79%) cases had successful outcome including 94/114 (82%) in post-Xpert group versus 105/138 (76%) in pre-Xpert group (OR:0.68; 95%CI:0.36,1.26). Conclusion We observed that availability of Xpert for initial diagnosis significantly reduced the time to SLD treatment for RIF-resistant patients in the Vladimir TB Dispensary. Although implementation of rapid diagnostics did not improve treatment outcomes, early diagnosis of MDR-TB is important for selection of appropriate treatment regimen and prevention of transmission of drug-resistant strains of TB.

Background Despite being one of the most ancient diseases, tuberculosis (TB) is still a major health problem globally. It is one of the most important causes of death worldwide. GeneXpert MTB/RIF assay is a fast nucleic acid amplification test used for detection of TB as well as identification of rifampicin resistance. Design This was a cross-sectional study. Setting The study was conducted at Fayoum Chest Hospital, Egypt, between December 2017 and December 2018. Objectives To evaluate GeneXpert MTB/RIF in detection of Mycobacterium tuberculosis in Fayoum Chest Hospital. Patients and methods One hundred participants were enrolled in this study with clinical or radiological susceptibility of pulmonary or extrapulmonary TB. All patients underwent the following: full history taking, clinical examination, plain chest radiography, examination of specimen by Ziehl–Neelsen stain, cultivation on Lowenstein–Jensen media, and processed in GeneXpert MTB/RIF. Results GeneXpert assay is a good, fast, noninvasive, and accurate diagnostic tool for detection of M. tuberculosis, showing sensitivity of 100.0%, specificity of 85.0%, positive predictive value of 96.4%, negative predictive value of 100%, and accuracy of 97%. On the contrary, Ziehl–Neelsen had sensitivity of 83.75%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 60.61%. Conclusion GeneXpert is a fast, accurate, and promising technique with good sensitivity and specificity, but it cannot be used alone as a diagnostic tool for TB.

Spinal tuberculosis (TB), the most common form of musculoskeletal tuberculosis, is an infection-related disease globally, with paraplegia occurring in severe cases. Therefore, identification of spinal TB at an early stage is important for early intervention and eventual therapy. In this study, we conducted a prospective cohort study in routine clinical practice to investigate the diagnosis of different TB tests. A total of 519 patients were recruited based on the radiology of spinal TB. The diagnostic model was computed by regression analysis and was determined by receiver operating characteristic (ROC) curve analysis. Specificity, sensitivity, predictive value, likelihood ratio, and accuracy were also computed and compared. GeneXpert MTB/RIF showed a higher positive rate compared to that in the acid-fast bacilli smear and Mycobacterium culture. The results also showed that the Mycobacterium tuberculosis-specific antigen/phytohemagglutinin ratio in the T-SPOT assay had a good performance in the preoperative diagnosis and prediction of spinal TB. The diagnostic model based on the ratio of tuberculosis-specific antigen/phytohemagglutinin combined with GeneXpert MTB/RIF showed better efficiency for spinal TB diagnosis. In summary, the tuberculosis-specific antigen/phytohemagglutinin ratio combined with GeneXpert MTB/RIF could provide an early diagnosis of spinal TB.

Background: Very few studies report resistance pattern exclusively in musculoskeletal tuberculosis (MSK-TB). Methods: This study of 100 pus samples from patients of MSK-TB with active disease in whom Mycobacterium tuberculosis (MTB) was detected by cartridge-based nucleic acid amplification test (CBNAAT), revealed the pattern of resistance among newly diagnosed and previously treated cases. Liquid culture and drug susceptibility testing (DST) using MGIT 960 was done for 11 anti-tubercular drugs. Results: Among these 100 cases; 22% were AFB positive; MGIT 960 detected MTB in 58.33% (35/60) new cases and 30.0% (12/40) previously treated cases. Five new and 10 previously treated cases had drug resistance and 12 were detected rifampicin resistance (Rif-R) by CBNAAT. Among new cases MGIT-DST detected mono-INH resistant in 2.86% (1/35), mono-STR resistant in 2.86% (1/35), MDR-TB in 5.7% (2/35) and pre-XDR in 2.9%(1/35).Among previously treated cases Rif-R was found in 10% (4/40) where MTB was not detected by MGIT and MGIT-DST detected mono-INH resistant in 8.33% (1/12); MDR-TB in 8.33% (1/12) and pre-XDR in 33.3%. There were no cases of XDR-TB. Conclusion: High disease burden of various type drug resistance were seen more commonly in previously treated cases and was not uncommon in new cases of MSK-TB. Both CBNAAT and DST are essential for detecting resistance pattern in MSK-TB. [ABSTRACT FROM AUTHOR]

Purpose: currently TB diagnosis is limited by some major limitations in low income and less experienced hospitals. Recently, it has been proposed that the ku gene of mycobacterial strains has the potential to be a highly specific and sensitive candidate biomarker for molecular detection of Mycobacterium tuberculosis (Mtb). This study was aimed to evaluate the specificity and sensitivity of a real-time PCR assay for detection of ku gene in Mtb complex to determine its applicability for Mtb identification. Materials and methods: The identification of Mtb was confirmed using Gene Xpert assay. Specific primers for ku gene were designed and the cycle threshold (Ct) value from the real-time PCR was used as a proxy measure of the cut-off point. Receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic performance of ku gene in detecting Mtb directly from clinical specimens. Results: ku amplification was interpreted as positive and negative based on Ct values, in which a value <38 was considered positive and a value >40 was considered negative. Our findings revealed that the ku gene was found to be distributed in all Mtb-positive samples. Of note, none of the Mtb-negative exhibited a specific signal in a maximum of 40 cycles. Conclusions: The ku gene amplification using real-time PCR indicated high sensitivity and specificity for the detection of Mtb complex in sputum samples. [ABSTRACT FROM AUTHOR]

Cutaneous tuberculosis (CTB) is the rarest case of extrapulmonary TB comprising 2% of total cases. It's often a challenge both clinically and diagnostically. 1) To determine prevalence, age & gender-wise distribution of CTB. 2) To assess various diagnostic, microbiological modalities for the diagnosis of CTB. 76 skin biopsy specimens from suspected CTB lesions were analysed using following methods - Acid-fast Bacilli (AFB) staining (Ziehl-Neelsen method), growth of mycobacteria in culture (Lowenstein-Jensen media), and Gene Xpert MTB/RIF, Histopathological (H&E staining). Of the 76 specimens, 44 were males and 32 were females. The most commonly affected age group was 40-59 years. Infections were least common in 0-19 years age group. AFB was not seen in any of the primary smears. 10 were confirmed as CTB by the recovery of Mycobacterium in solid culture. Of the 10 culture positives, 9 were confirmed as MTB, and 1 was found to be NTM. Staining of 10 culture positive specimens revealed acid fast, beaded rods. Detection of MTB by Gene Xpert gave positive result in 9 cases with all RIF sensitive. All 9 PCR confirmed cases were also culture positive, all 9 were slow growers with a minimum of 5 weeks required for growth on the LJ slant. PCR is the test of choice and should be performed on all specimens of suspected CTB. However when coupled with the "gold standard" culture method, the diagnostic accuracy improves. Also, further, culture helps in identification and isolation of NTM's. [ABSTRACT FROM AUTHOR]

Objectives: India has the largest burden of MDR-TB worldwide, with an annual incidence of 1,30 000 patients. Multidrug-resistant tuberculosis (MDR-TB) carries a poor prognosis, a high mortality rate, and treatment success rates as low as 65%. The mortality in India is estimated to be about 480,000 per year. The aim of the study was to evaluate Rifampicin-resistant Tuberculosis and its distribution by GeneXpert in a tertiary care hospital. Methods: A total of 2864 samples were processed from the patients attending outpatient departments and indoor wards as per the pediatrician's request. Acid-fast bacilli (AFB) smear microscopy was done on all samples by Acid-fast staining for early diagnosis followed by GeneXpert MTB/RIF (CBNAAT) testing. Specimens were transported and stored at 2-8 °C prior to processing for CBNAAT. Results were read and reported within 2 hours. Results: A total of 2864 samples were tested for TB using CBNAAT (including 645 [22.5%] extra-pulmonary and 2219 [77.5%] pulmonary samples). The test results were positive in a total of 346 (12%) samples by CBNAAT. The positivity is highest in the age group >10 years and in sputum samples (37.28%) followed by pus samples (23.26%) in pulmonary and extrapulmonary distribution. Out ZN staining was positive in 244 (8.5%) specimens. There were 102 (29.5%) CBNAAT positive specimens which showed negative results for Acid-fast bacilli (70.52% Sensitivity). Among 346 TB-positive patients, 10.46% samples were pulmonary and 17.67% were extrapulmonary. It was observed that in positive CBNAAT patients, the prevalence of Rifampicin resistance was 12.72% i.e. 44 samples which include 31(13.36%) and 13(11.40%) pulmonary and extra-pulmonary samples respectively. Among the Rifampicin resistant samples, there were 29.55% samples that were extrapulmonary. Conclusion: GeneXpert MTB/RIF is a very rapid diagnostic assay that provides information regarding the mutation pattern of RIF resistance in MTB isolates. [ABSTRACT FROM AUTHOR]

Objective To analyze the efficacy of Genexpert MTB / RIF in the detection of Mycobacterium tuberculosis and rifampicin resistance in different types of specimens, and we evaluate the valve of Genexpert MTB / RIF to detect Mycobacterium tuberculosis. Methods Totally 7 687 specimens of BACTEC MGIT 960 culture (MGIT 960) positive in Xi'an Chest Hospital from January 1, 2019 to December 31, 2020 were selected as the research objects, MGIT 960 and Micro DST test were used as standard to analyze the efficacy of GeneXpert MTB/RIF to detect Mycobacterium tuberculosis (MTB) and its drug resistance in different sputums. Results With MGIT 960 as standard, the sensitivity of GeneXpert MTB / RIF of detect MTB in sputum samples, bronchoalveolar lavage samples (BALF), serous cavity effusion, pus and tissue samples were 75.1% (653/869), 82.1% (1 093/1 332), 57.3% (110/192), 80.0% (60/75), 77.3% (34/44), and had significant difference between these specimens (χ² = 64.100, P < 0.001). With Micro DST as standard, the sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of GeneXpert MTB / RIF in detecting rifampicin resistance of Mycobacterium tuberculosis were 95.3%, 95.2%, 74.9%, 99.3% and 0.81 respectively; With Micro DST as standard, the sensitivity, specificity and Kappa value of GeneXpert MTB / RIF in detecting rifampicin resistance in sputum samples, BALF, serous cavity effusion, pus and tissue samples were 94.6%, 95.1%, 0.83; 95.1%, 95.2%, 0.78; 100%, 97.3%, 0.89; 100%, 92.3%, 0.73l100%, 90.9%, 0.86. Conclusion GeneXpert MTB / RIF has high sensitivity in the detection of Mycobacterium tuberculosis in sputum samples, BALF, serous cavity effusion, pus and tissue samples, and can be used as an effective method for the detection of tuberculosis. The accuracy of GeneXpert MTB / RIF in detecting rifampicin resistance of Mycobacterium tuberculosis was higher in sputum samples, BALF, serous cavity effusion (including pleural fluid, ascites and cerebrospinal fluid), pus and tissue samples. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to produce Geo Spatial Distribution of Frequencies of MTB/RIF Detected Specimens based on Requesting Health Facilities in Manicaland Zimbabwe for 2017 and 2018, so as to give insight to TB program managers. Focusing elimination interventions on hot pockets of Tuberculosis (TB) strengthens rationale use of resources in resource limited countries like Zimbabwe. Early detection and early treatment is backbone of breaking TB transmission. Drug resistant tuberculosis (DRTB) control interventions like Programmatic Management of Drug Resistant TB or mentoring on Short, all Oral Regimen for Rifampicin resistant Tuberculosis (ShORRT) will be driven by science. Materials and Methods: The retrospective study was carried out in Manicaland, Zimbabwe. Manicaland one of the 10 provinces in Zimbabwe, has 7 districts with 308 health facilities. During this retrospective cross sectional study 2221 MTB detected results of 2017 and 2018, downloaded from 14 of the 15 Genexpert sites in Manicaland were employed to generate hotspot maps. Fifteenth Genexpert site lost its electronic records when Genexpert CPU crushed. Geographical Positioning System (GPS) of the health facilities were recorded.The study used MTB detected frequencies at a facility in relation to surrounding facilities in Manicaland, then ran optimised hotspot analysis function in Arc Map 10.5 to implement the Gi* statistic. Results: Overall provincial MTB detected positivity was 2221/36055 (6.2%). Overall provincial Rifampicin Resistant (RR) positivity was. 111.2221(5.0%). Geo-spatial map of Manicaland showed 10 facilities that are RR hotspots with 7/10 (70%) of the facilities in Buhera district. Chipinge district had facilities that were MTB detected high hotspots.For the whole of Manicaland, Buhera district had100% MTB detected low hotspots facilities. Ninety percent hotspots were clustered around 2 of the 15 Genexpert Sites in Manicaland, namely Murambinda Mission Hospital and Chipinge District Hospital. Conclusion: Study identified health facilities with high frequencies of RR areas. For the identified health facilities with high frequencies of RR specimens, NTP may focus DRTB control interventions like PMDT, or mentoring on ShORRT. For the health facilities with high frequencies of MTB detected NTP can focus trainings in TB Case Management. Instead of uniformly spreading the limited resources to all 325 facilities, efforts streamlined to manageable number of 20 facilities in commensurate with identified gap(e.g. objective selection of cadres for training, data driven supportive supervision & targeted awareness campaigns). [ABSTRACT FROM AUTHOR]

Abstract Background Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. Methods We conducted a pilot randomized trial to evaluate the impact of GeneXpert screening on a mobile HIV testing unit. Adults (≥18y) underwent rapid HIV testing and TB symptom screening and were randomized to usual mobile unit care (providing sputum on the mobile unit sent out for GeneXpert testing) or the “Test & Treat TB” intervention with immediate GeneXpert testing. Symptomatic participants in usual care produced sputum that was sent for hospital-based GeneXpert testing; participants were contacted ~ 7 days later with results. In the “Test & Treat TB” intervention, HIV-infected or HIV-uninfected/TB symptomatic participants underwent GeneXpert testing on the mobile unit. GeneXpert+ participants received expedited TB treatment initiation, monthly SMS reminders and non-cash incentives. We assessed 6-month TB treatment outcomes. Results 4815 were eligible and enrolled; median age was 27 years (IQR 22 to 35). TB symptoms included cough (5%), weight loss (4%), night sweats (4%), and fever (3%). 42% of eligible participants produced sputum (intervention: 56%; usual care: 26%). Seven participants tested GeneXpert+, six in the intervention (3%, 95% CI 1%, 5%) and one in usual care (1%, 95% CI 0%, 6%). 5 of 6 intervention participants completed TB treatment; the GeneXpert+ participant in usual care did not. Conclusion GeneXpert MTB/RIF screening on a mobile HIV testing unit is feasible. Yield for GeneXpert+ TB was low, however, the “Test & Treat TB” strategy led to high rates of TB treatment completion. Trial registration This study was registered on November 21, 2014 at ClinicalTrials.gov (NCT02298309).

ABSTRACTRapid and simple-to-use diagnostic methods for tuberculosis are urgently needed. Recent development has unveiled the diagnostic power of the CRISPR system in the detection of viral infections. However, its potential use in detecting the Mycobacterium tuberculosis complex (MTB) remained unexplored. We developed a rapid CRISPR-based assay for TB detection and conducted a retrospective cohort study of 179 patients to evaluate the CRISPR-MTB test for identifying MTB in various forms of direct clinical samples. Its diagnostic performance was compared, in parallel with culture and the GeneXpert MTB/RIF assay (Xpert). The CRISPR-MTB test is highly sensitive with a near single-copy sensitivity, demands less sample input and offers shorter turnaround time than Xpert. When evaluated in the clinical cohort of both pulmonary and extra-pulmonary tuberculosis, the CRISPR-MTB test exhibited an overall improved sensitivity over both culture (79% vs 33%) and Xpert (79% vs 66%), without comprise in specificity (62/63, 98%). The CRISPR-MTB test exhibits an improved overall diagnostic performance over culture and Xpert across a variety of sample types, and offers great potential as a new diagnostic technique for both pulmonary and extra-pulmonary tuberculosis.

Abstract Background The GeneXpert MTB/RIF Assay (Xpert®) is known to be a feasible, effective and a hopeful tool for rapid tuberculosis (TB) diagnosis and treatment. However, little is known about the time delay caused by initial negative sputum smear microscopy (NSSM), but consecutive positive Xpert TB test (PXTBt) and its association with TB mortality in resource-constrained settings. We aimed to estimate the median time delay between initial NSSM but consecutive PXTBt and TB treatment initiation and its association with TB mortality among TB/HIV co-infected patients in Beira, Mozambique. Methods we used data from a retrospective cohort study of TB/HIV co-infected patients in six TB services in Beira city. The study included all patients that tested NSSM, followed by a PXTBt in the six health centers with TB services during the year 2015. Data were extracted from the laboratory and TB treatment registers. To assess the difference in median time delays between groups, Mann-Whitney and Kruskal-Wallis tests were computed. To analyze the associations between the time delays and TB mortality, logistic regression model was used. Results Among the 283 patients included in the study, median (IQR) age was 31 (17) years, 59.0% were males, 57.6% in the WHO clinical fourth stage of HIV. The median (IQR) values for diagnostic delay, treatment delay and total time delay was 10 (9) days, 13 (12) days and 28 (20) days, respectively. For TB/HIV co-infected patients who tested negative for smear microscopy initially, a total time delay of one month or longer was associated with high mortality (aOR = 12.40, 95% CI: 5.70–22.10). Conclusion Our study indicates that delays in TB diagnosis and treatment resulting from initial NSSM, but consecutive PXTBt are common in Beira city and are one of the main factors associated with TB mortality among TB/HIV co-infected patients. Applying GeneXpert assay as gold standard for HIV-positive patients with suspected pulmonary TB or replacing the sputum smear microscopy by Xpert assay and its availability within 24 h is urgently needed to ensure early diagnosis and treatment, and to maximize the impact of the few resources available in the country.

Background We describe the performance of GeneXpert MTB/RIF (Xpert) for diagnosing tuberculosis (TB) among symptomatic household contacts (HHCs) of rifampicin-resistant and drug-sensitive index cases. Methods We conducted a cross-sectional study among HHCs of recently diagnosed (<2 weeks) smear-positive and Xpert-positive index cases in the Bojanala District, South Africa. The HHCs were screened for TB symptoms; persons with ≥1 TB symptom provided 1 sputum for smear microscopy, Xpert, and mycobacterial growth indicator tube (MGIT) culture. Diagnostic test performance of Xpert was determined using MGIT as the reference standard. Results From August 2013 to July 2015, 619 HHCs from 216 index cases were enrolled: 60.6% were female, median age was 22 years (interquartile range, 9–40), and 126 (20.4%) self-reported/tested human immunodeficiency virus positive. A total of 54.3% (336 of 619) of contacts had ≥1 TB symptom (cough, fever, night sweats, weight loss), 297 of 336 (88.4%) of which provided a sputum; 289 (97.3%) had complete testing and 271 were included in the analysis. In total, 42 (6.8%) of 619 HHCs had microbiologically confirmed TB. The MGIT identified 33 HHCs as positive for Mycobacterium tuberculosis ; of these, 7 were positive on Xpert resulting in a sensitivity of 21.2% (95% confidence interval [CI], 9.0–38.9), specificity of 98.3% (95% CI, 95.6–99.5), positive predictive value of 63.6% (95% CI, 30.8–89.1), and negative predictive value of 90.0 (95% CI, 85.7–93.4). Conclusions Among symptomatic HHCs investigated for TB, Xpert performed suboptimally compared with MGIT culture. The poor performance of Xpert for diagnosing TB suggests that a more sensitive test, such a Xpert Ultra or culture, may be needed to improve yield of contact investigation, where feasible. [ABSTRACT FROM AUTHOR]

• This study proposes acid-fast staining combined with GeneXpert MTB/RIF to diagnose non-tuberculous mycobacteria pulmonary disease (NTM-PD). • The combined method for NTM-PD was found to be effective during the waiting period for culture results. • The more detection times of acid-fast staining, the higher the diagnostic sensitivity. To evaluate the clinical diagnostic value of positive acid-fast staining combined with negative GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease (NTM-PD). A total of 133 inpatients with confirmed NTM-PD were included consecutively between January 1, 2018 and December 31, 2019, at Tongji Hospital and Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, in Wuhan, China. One hundred patients with confirmed pulmonary tuberculosis (PTB) were randomly included as the control group. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of positive acid-fast staining combined with a negative GeneXpert MTB/RIF result were 51.13% (95% confidence interval (CI) 42.52–59.73%), 97.00% (95% CI 93.60–100.40%), 95.78% (95% CI 90.98–100.57%), and 59.88% (95% CI 52.25–67.51%), respectively. When subjects were limited to patients with positive acid-fast staining, the sensitivity of a negative GeneXpert MTB/RIF result was 88.31% (95% CI 80.97–95.65%). When acid-fast staining was conducted ≥3 times, the sensitivity of this combination diagnosis method increased to 61.67% (95% CI 49.00–74.33%). Positive acid-fast staining combined with a negative GeneXpert MTB/RIF result could be an effective and time-saving method for the diagnosis of NTM-PD. [ABSTRACT FROM AUTHOR]

Retropharyngeal abscess is an uncommon location of tuberculosis (TB). In this report, we describe a multidrug-resistant tuberculous retropharyngeal abscess in a 21-year-old female patient who was treated for lymph node TB for one year. CT scan revealed a large retropharyngeal abscess that was aspirated intraorally under local anesthesia. The diagnosis of TB was retained by molecular and histological study. GeneXpert MTB/ RIF (Cepheid, Sunnyvale, CA, USA),performed on the pus, showed rifampicin resistance and a first- and second-line drug resistance test using Genotype MTBDRplus VER.2 and MTBDRsl VER.1 (Hain Lifescience GmbH, Nehren, Germany) showed TB highly resistant to rifampicin, isoniazid, and aminoglycosides. Treatment is primarily medical as it combines specific antituberculous antibiotics, and aspiration for drainage of the abscess. Our patient was put on long-term 2nd line anti-TB treatment.