PMID- 24622091
OWN - NLM
STAT- MEDLINE
DCOM- 20150105
LR  - 20220408
IS  - 1098-660X (Electronic)
IS  - 0095-1137 (Print)
IS  - 0095-1137 (Linking)
VI  - 52
IP  - 6
DP  - 2014 Jun
TI  - Diagnostic accuracy of Xpert MTB/RIF for extrapulmonary tuberculosis specimens: 
      establishing a laboratory testing algorithm for South Africa.
PG  - 1818-23
LID - 10.1128/JCM.03553-13 [doi]
AB  - South Africa implemented Xpert MTB/RIF as the initial diagnostic test for 
      pulmonary tuberculosis (TB). Xpert MTB/RIF's accuracy for diagnosing 
      extrapulmonary tuberculosis (EPTB) was investigated. EPTB specimens (n = 7,916) 
      from hospitalized patients received over a 6-month period at a high-throughput TB 
      referral laboratory in Johannesburg were investigated. Large-volume specimens 
      were centrifuged, tissue biopsy specimens homogenized, and all specimens checked 
      for growth of contaminating bacteria on blood agar. Contaminated samples received 
      NALC-NaOH (N-acetyl-l-cysteine-sodium hydroxide) decontamination prior to liquid 
      culture. Residual specimens (volumes > 1 ml) after inoculation of culture (n = 
      1,175) were tested using the Xpert MTB/RIF sputum protocol. Using culture as the 
      reference, Xpert MTB/RIF's overall sensitivity was 59% (95% confidence interval 
      [95% CI], 53% to 65%) and specificity was 92% (CI, 90% to 94%), with the highest 
      sensitivities of 91% (95% CI, 78% to 97%) for pus, 80% (95% CI, 56% to 94%) for 
      lymph node aspirates, and 51% (95% CI, 44% to 58%) for fluids (ascitic, 59%; 
      pleural, 47%). A difference in sensitivities was noticed between specimens 
      classified as having a thick (87% [95% CI, 76% to 94%]) versus clear (watery) 
      (48% [95% CI, 36% to 61%]) appearance. This was unchanged with traces of blood 
      (52% [95% CI, 44% to 60%]) or precentrifugation (57% [95% CI, 28% to 82%]) among 
      clear specimens. Xpert MTB/RIF generated an additional 124 specimen results that 
      were contaminated by Mycobacterial Growth Indicator Tubes (MGIT; 10.5%) and 
      diagnosed rifampin (RIF) resistance earlier (9.6% [25/260]). Xpert MTB/RIF's 
      performance on EPTB specimens provides very promising results and should be 
      considered for incorporation into national TB guidelines. Xpert MTB/RIF is less 
      affected by contaminating bacteria and reduces laboratory labor and diagnostic 
      delay compared to traditional methods.
CI  - Copyright (c) 2014, American Society for Microbiology. All Rights Reserved.
FAU - Scott, Lesley Erica
AU  - Scott LE
AD  - Department of Molecular Medicine and Haematology, School of Pathology, Faculty of 
      Health Science, University of the Witwatersrand, Johannesburg, South Africa 
      lesley.scott@nhls.ac.za.
FAU - Beylis, Natalie
AU  - Beylis N
AD  - National Health Laboratory Service, South Africa Division of Clinical 
      Microbiology and Infectious Diseases; University of the Witwatersrand, 
      Johannesburg, South Africa.
FAU - Nicol, Mark
AU  - Nicol M
AD  - Division of Medical Microbiology, Department of Clinical Laboratory Sciences and 
      Institute for Infectious Diseases and Molecular Medicine, University of Cape 
      Town, Cape Town, South Africa National Health Laboratory Service, South Africa.
FAU - Nkuna, Gloria
AU  - Nkuna G
AD  - Department of Molecular Medicine and Haematology, School of Pathology, Faculty of 
      Health Science, University of the Witwatersrand, Johannesburg, South Africa.
FAU - Molapo, Sebaka
AU  - Molapo S
AD  - National Health Laboratory Service, National Priority Program, Johannesburg, 
      South Africa.
FAU - Berrie, Leigh
AU  - Berrie L
AD  - National Health Laboratory Service, National Priority Program, Johannesburg, 
      South Africa.
FAU - Duse, Adriano
AU  - Duse A
AD  - National Health Laboratory Service, South Africa Division of Clinical 
      Microbiology and Infectious Diseases; University of the Witwatersrand, 
      Johannesburg, South Africa.
FAU - Stevens, Wendy Susan
AU  - Stevens WS
AD  - Department of Molecular Medicine and Haematology, School of Pathology, Faculty of 
      Health Science, University of the Witwatersrand, Johannesburg, South Africa 
      National Health Laboratory Service, National Priority Program, Johannesburg, 
      South Africa.
LA  - eng
GR  - U2G PS001328/PS/NCHHSTP CDC HHS/United States
GR  - 3U2GPS0001328-04/PHS HHS/United States
GR  - PEPFAR/PEPFAR/United States
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20140312
PL  - United States
TA  - J Clin Microbiol
JT  - Journal of clinical microbiology
JID - 7505564
RN  - 0 (Antitubercular Agents)
RN  - VJT6J7R4TR (Rifampin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Algorithms
MH  - Antitubercular Agents/pharmacology
MH  - Bacteriological Techniques/*methods
MH  - Body Fluids/microbiology
MH  - Child
MH  - Child, Preschool
MH  - Drug Resistance, Bacterial
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Lymph Nodes/microbiology
MH  - Male
MH  - Middle Aged
MH  - Molecular Diagnostic Techniques/*methods
MH  - Rifampin/pharmacology
MH  - Sensitivity and Specificity
MH  - South Africa
MH  - Tuberculosis/*diagnosis
MH  - Young Adult
PMC - PMC4042800
EDAT- 2014/03/14 06:00
MHDA- 2015/01/06 06:00
PMCR- 2014/12/01
CRDT- 2014/03/14 06:00
PHST- 2014/03/14 06:00 [entrez]
PHST- 2014/03/14 06:00 [pubmed]
PHST- 2015/01/06 06:00 [medline]
PHST- 2014/12/01 00:00 [pmc-release]
AID - JCM.03553-13 [pii]
AID - 03553-13 [pii]
AID - 10.1128/JCM.03553-13 [doi]
PST - ppublish
SO  - J Clin Microbiol. 2014 Jun;52(6):1818-23. doi: 10.1128/JCM.03553-13. Epub 2014 
      Mar 12.