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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Evaluation of Xpert MTB/RIF for detection of tuberculosis from blood samples of HIV-infected adults confirms Mycobacterium tuberculosis bacteremia as an indicator of poor prognosis
Journal of Clinical Microbiology, Volume 51, No. 7, Year 2013
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Description
Tuberculosis (TB) remains a leading cause of death among HIV-infected adults, in part because of delayed diagnosis and therefore delayed initiation of treatment. Recently, the Gene-Xpert platform, a rapid, PCR-based diagnostic platform, has been validated for the diagnosis of TB with sputum. We have evaluated the Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis bacteremia and investigated its impact on clinical outcomes. Consecutive HIV-infected adults with fever and cough presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, were recruited and followed up for 2 months. At presentation, three sputum samples were examined by smear, culture, and Xpert MTB/RIF assay for the presence of M. tuberculosis and blood was drawn for PCR with Xpert, for mycobacterial culture (Myco/F Lytic), and for aerobic culture. One hundred four patients were recruited, and 44 (43%) were sputum culture positive forM. tuberculosis. Ten were Xpert blood positive, for a sensitivity of 21% and a specificity of 100%. The 2-week mortality rate was significantly higher among patients who were Xpert blood positive than among those who were negative (40% versus 3%; multivariate odds ratio [OR] for death if positive, 44; 95% confidence interval [CI], 3 to 662). This effect persisted on assessment of the mortality rate at 2 months (40% versus 11%; OR, 5.6; 95% CI, 1.3 to 24.6). When screening uncomplicated patients presenting with a productive cough for pulmonary TB, Xpert blood offers no diagnostic advantage over sputum testing. Despite this, Xpert blood positivity is highly predictive of early death and this test rapidly identifies a group of patients in urgent need of initiation of treatment. © 2013 Feasey et al.
Authors & Co-Authors
Feasey, Nicholas A.
Unknown Affiliation
Banada, Padmapriya P.
Unknown Affiliation
Howson, Will
Unknown Affiliation
Sloan, D. J.
Unknown Affiliation
Mdolo, Aaron
Unknown Affiliation
Boehme, Catharina C.
Unknown Affiliation
Chipungu, Geoffrey
Unknown Affiliation
Allain, Theresa Jane
Unknown Affiliation
Heyderman, Robert Simon
Unknown Affiliation
Corbett, Elizabeth L.
Unknown Affiliation
Alland, David
Unknown Affiliation
Statistics
Citations: 55
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1128/JCM.00330-13
ISSN:
00951137
e-ISSN:
1098660X
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Study Design
Case-Control Study
Study Locations
Malawi