Comparison of ZN Microscopy, Culture on LJ Media and Gene Xpert MTB/RIF Assay in Diagnosis of Extra-Pulmonary Tuberculosis
AS Boinwad1 and JA Iravane2*
1Assistant Professor at Swami Ramanand Teerth Rural Government Medical College, Ambajogai, Maharashtra, India
2M.D. Microbiology, Professor and Head of Department of Microbiology, Government Medical College, Aurangabad, India
*Corresponding Author: Dr. JA Iravane, Professor and Head of Department,
Department of Microbiology, Government Medical College, Aurangabad, Maharashtra, India.
Received: August 26, 2021; Published: September 20, 2021
Tuberculosis is caused by Mycobacterium tuberculosis and classified as pulmonary tuberculosis (PTB) and Extra Pulmonary tuberculosis (EPTB). EPTB account for 15-20 % cases of tuberculosis. EPTB diagnosis is challenging due to inadequate sample volume, pauci-bacillary nature and unusual clinical presentation. This study determined the role of Gene Xpert MTB/RIF assay in diagnosis of EPTB and compared results with conventional smear microscopy and culture on LJ media.
All the samples coming to our laboratory during January 2015 to June 2016 were processed with Gene Xpert MTB/RIF assay, Smear microscopy and LJ media culture. Total samples examined were 514. 90(17.51%) samples were positive by Gene Xpert MTB/RIF assay of these 15 samples shows Rifampicin resistance. Samples which were positive by culture and smear microscopy were 58(11.28%) and 28(5.45%) respectively.
To conclude, we can say that Gene Xpert MTB/RIF assay is the novel test for rapid diagnosis of Extra Pulmonary Tuberculosis.
Keywords: Gene Xpert MTB/RIF Assay; Extra Pulmonary Tuberculosis
- Jain A. “Extra pulmonary tuberculosis: A diagnostic dilemma”. Indian Journal of Clinical Biochemistry3 (2011): 269-273.
- Pai M and Nathavitharana R. “Extrapulmonary tuberculosis: new diagnostics and new policies”. Indian Journal of Chest Diseases and Allied Sciences 2 (2014): 71-73.
- Global Tuberculosis Report 2016. Cdc 2016. 2016 (Global TB Report 2016) (2016).
- Golden MP and Vikram HR. “Extrapulmonary tuberculosis: An overview”. American Family Physician 9 (2005): 1761-1768.
- Sharma SK and Mohan A. “Extrapulmonary Tuberculosis”. Indian Journal of Immunology and Respiratory Medicine (2004): 316-353.
- Mehta PK., et al. “Diagnosis of extrapulmonary tuberculosis by PCR”. FEMS Immunology and Medical Microbiology 1 (2012): 20-36.
- Chakravorty S., et al. “Diagnosis of Extrapulmonary Tuberculosis by Smear, Culture, and PCR Using Universal Sample Processing Technology Diagnosis of Extrapulmonary Tuberculosis by Smear, Culture, and PCR Using Universal Sample Processing Technology”. Journal of Clinical Microbiology 9 (2005): 4357-4362.
- Desai SL and Pol S. “A comprehensive comparision of mpb64 based pcr assay versus microscopy and culture in the diagnosis of clinically suspected cases of extrapulmonary tuberculosis”. (2015).
- Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children: Policy Update (2013): 97.
- Avashia S., et al. “Comparison of conventional methods with gene xpert mtb/rif assay for rapid detection of mycobacterium tuberculosis and rifampicin resistance in extra-pulmonary samples” 4.2 (2016): 181-185.
- Iram S., et al. “Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay - Report from a developing country”. Pakistan Journal of Medical Science1 (2014): 105-110.
- Bajrami R., et al. “Comparison of genexpert MTB/RIF and conventional methods for the diagnosis of tuberculosis in Kosovo”. Journal of Infection in Developing Countries 4 (2016): 418-422.
- Balcha TT., et al. “Intensified tuberculosis case-finding in HIV-positive adults managed at ethiopian health centers: Diagnostic yield of xpert MTB/RIF compared with smear microscopy and liquid culture”. PLoS One1 (2014).
- Bates M., et al. “Assessment of the Xpert MTB/RIF assay for diagnosis of tuberculosis with gastric lavage aspirates in children in sub-Saharan Africa: A prospective descriptive study”. Lancet Infectious Disease1 (2013): 36-42.
- Chakravorty S and Tyagi JS. “Novel multipurpose methodology for detection of mycobacteria in pulmonary and extrapulmonary specimens by smear microscopy, culture, and PCR”. Journal of Clinical Microbiology6 (2005): 2697-2702.
- Denkinger CM., et al. “Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: A systematic review and meta-analysis”. European Respiratory Journal2 (2014): 435-446.
- Helb D., et al. “Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology”. Journal of Clinical Microbiology1 (2010): 229-237.
- Hillemann D., et al. “Rapid molecular detection of extrapulmonary tuberculosis by the automated genexpert MTB/RIF system”. Journal of Clinical Microbiology4 (2011): 1202-1205.
- Kashif Munir M., et al. “Comparison of Ziehl Neelsen Microscopy with GeneXpert for Detection of MycobacteriumTuberculosis”. IOSR Journal of Dental and Medical Sciences 11 (2015): 2279-2861.
- Kn P., et al. “Use of GeneXpert Assay for Diagnosis of Tuberculosis From Body Fluid Specimens, a 2 Years Study” (2016): 1-4.
- Ligthelm LJ., et al. “Xpert MTB/RIF for rapid diagnosis of tuberculous lymphadenitis from fine-needle-aspiration biopsy specimens”. Journal of Clinical Microbiology11 (2011): 3967-3970.
- Maynard-Smith L., et al. “Diagnostic accuracy of the Xpert MTB/RIF assay for extrapulmonary and pulmonary tuberculosis when testing non-respiratory samples: a systematic review. BMC Infectious Disease1 (2014): 709.
- Meawed TE and Shaker A.” Assessment of diagnostic accuracy of Gene Xpert MTB/RIF in diagnosis of suspected retreatment pulmonary tuberculosis patients”. Egyptian Journal of Chest Diseases and Tuberculosis 65 (2016): 637-641.
- Rufai SB., et al. “Performance of xpert MTB/RIF assay in diagnosis of pleural tuberculosis by use of pleural fluid samples”. Journal of Clinical Microbiology11 (2015): 3636-3638.
- Rufai S., et al. “Performance of Xpert MTB/RIF on ascitic fluid samples for detection of abdominal tuberculosis”. Journal of Laboratory Physicians1 (2017): 47.
- Sehgal IS., et al. “Diagnostic Performance of Xpert MTB / RIF in Tuberculous Pleural Effusion : Systematic Review and Meta-analysis”. Journal of Clinical Microbiology4 (2016): 1133-1136.
- Sharma SK., et al. “Evaluating the diagnostic accuracy of xpert MTB/RIF assay in pulmonary tuberculosis”. PLoS One (2015).
- Shrestha P., et al. “The Application of GeneXpert MTB/RIF for Smear-Negative TB Diagnosis as a Fee-Paying Service at a South Asian General Hospital”. Tuberculosis Research and Treatment 2015 (2015): 102430.
- Vadwai V., et al. “Xpert MTB/RIF: A new pillar in diagnosis of extrapulmonary tuberculosis?”. Journal of Clinical Microbiology7 (2011): 2540-2545.
- Tortoli E., et al. “Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis”. European Respiratory Journal2 (2012): 442-447.
- Zeka AN., et al. “Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens”. Journal of Clinical Microbiology12 (2011): 4138-4141.
- Noussair L., et al. “Early diagnosis of extrapulmonary tuberculosis by a new procedure combining broth culture and PCR”. Journal of Clinical Microbiology5 (2009): 1452-1457.
- Lawn SD and Nicol MP. “Xpert ® MTB / RIF assay : development , evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance”. Future Microbiology9 (2011): 1067-1082.
- Mid-prevalence areas in the lung and extrapulmonary tuberculosis diagnosis.
- Pai M., et al. “Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis”. Lancet Infectious Disease10 (2003): 633-643.
- Teo J., et al. “Comparison of two nucleic acid amplification assays, the Xpert MTB/RIF assay and the amplified mycobacterium tuberculosis direct assay, for detection of Mycobacterium tuberculosis in respiratory and nonrespiratory specimens”. Journal of Clinical Microbiology10 (2011): 3659-3662.
- Agrawal M., et al. “Comparative study of GeneXpert with ZN stain and culture in samples of suspected pulmonary tuberculosis”. Journal of Clinical and Diagnostic Research5 (2016): DC09-DC12.