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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Diagnostic accuracy and effectiveness of the Xpert MTB/RIF assay for the diagnosis of HIV-associated lymph node tuberculosis
European Journal of Clinical Microbiology and Infectious Diseases, Volume 32, No. 11, Year 2013
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Description
Xpert MTB/RIF (Xpert) is recommended for human immunodeficiency virus (HIV)-associated pulmonary tuberculosis but not extrapulmonary tuberculosis. We assessed the performance of Xpert for HIV-associated lymph node tuberculosis (LNTB), the most common type of extrapulmonary tuberculosis. Among HIV-infected adults suspected of LNTB presenting for fine needle aspirate (FNA) at a South African hospital, we assessed the diagnostic accuracy of Xpert using either FNA culture or a composite of microscopy, culture, and cytology as the reference standard, and evaluated the impact of different diagnostics on patient management. Among 344 adults with valid FNA culture and Xpert results, 84 (24 %) were positive on microscopy, 149 (43 %) on culture, 152 (53 %) on Xpert, and 181 (57 %) had a cytology result suggestive of tuberculosis. Using liquid culture as the reference standard, the specificity of a single Xpert was suboptimal (88.2 %) but the sensitivity was high [93.3 %, 95 % confidence interval (CI) 87.6-96.6] and increased with decreasing CD4 count (from 87.0 % for CD4 >250 to 98.6 % for CD4 <100 cells/mm3). Using a composite reference standard reduced the sensitivity to 79.2 % but increased the specificity to 98.6 %. All Xpert-positive patients initiated treatment within one day, compared to 70 % of culture-positive but Xpert-negative and 13 % of culture- and Xpert-negative but cytology-positive patients. Xpert is accurate and effective and could be endorsed as the initial diagnostic for HIV-associated LNTB. © 2013 Springer-Verlag Berlin Heidelberg.
Authors & Co-Authors
van Rie, Annelies
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Page-Shipp, Liesl Shirley
South Africa, Johannesburg
Right to Care
Mellet, K.
South Africa, Johannesburg
University of the Witwatersrand
Scott, Lesley Erica
South Africa, Johannesburg
University of the Witwatersrand
Mkhwnazi, M.
South Africa, Johannesburg
Right to Care
Jong, Eefje
South Africa, Johannesburg
University of the Witwatersrand
Omar, Tanvier
South Africa, Johannesburg
National Health Laboratory Service
Beylis, Natalie C.
South Africa, Johannesburg
National Health Laboratory Service
Stevens, Wendy Susan
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Johannesburg
National Health Laboratory Service
Sanne, Ian
South Africa, Johannesburg
Right to Care
South Africa, Johannesburg
University of the Witwatersrand
Menezes, Colin Nigel
South Africa, Johannesburg
University of the Witwatersrand
Statistics
Citations: 21
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1007/s10096-013-1890-0
ISSN:
09349723
e-ISSN:
14354373
Research Areas
Health System And Policy
Infectious Diseases