•  
  •  
 

Abstract

Introduction. Xpert MTB/RIF test on gastric lavage sample may improve pulmonary tuberculosis (TB) case finding, but its performance as a diagnostic test for pulmonary TB in HIV-infected adults patients has not been studied widely, including in Indonesia. This study aims to determine the performance of the Xpert MTB/RIF test in diagnosing pulmonary tuberculosis 30 | Jurnal Penyakit Dalam Indonesia | Vol. 5, No. 1 | Maret 2018 Manuel Lamberto Willem Mboeik, Ceva Wicaksono Pitoyo, Teguh Harjono Karjadi, Anis Karuniawati, Esthika Dewiasty among HIV-infected adult patients with suspected pulmonary tuberculosis by using gastric lavage sample. Method. A cross-sectional study was conducted on adult HIV-infected patients with suspected pulmonary tuberculosis in Cipto Mangunkusumo hospital Jakarta between February 2016 and June 2017. Gastric lavage sample and sputum sample collection were performed for Xpert MTB/RIF test and acif fast bacilli (AFB) smear examination. Results. Among total of 117 subjects, 81 (69,2%) subjects were unable to expectorate sputum. M tuberculosis was detected on Xpert MTB/RIF using gastric lavage samples in 34 (29,1%) subjects, AFB in 4 of 36 sputum samples and 2 of 117 gastric lavage samples. The drug sensitivity test on all 34 Xpert MTB/RIF positive subjects showed no rifampicin resistance. Fifty-one (43.6%) subjects were diagnosed as clinical pulmonary tuberculosis, 26 subjects among them were positive on Xpert MTB/ RIF assay, 4 subjects were smear sputum positive and 1 subject was gastric lavage smear positive. Using clinical diagnosis of pulmonary TB as gold standard, a single Xpert MTB/RIF assay using gastric lavage sample showed sensitivity of 50.98% (95% CI: 36.6-65.25), specificity 87.88% (95% CI: 77,1-94,62), positive predictive value 76,47% (95%CI: 61,67-86,78) and negative predictive value 69,88% (95% CI: 63,36-75.68). Conclusion. Xpert MTB/RIF performed on gastric lavage samples showed sensitivity of 50.98% and specificity 87.88% in clinical diagnosis of pulmonary tuberculosis in HIV-positive patients with pulmonary tuberculosis.

References

1. Mayer KH, Hamilton CD. World synergistic pandemics confronting the global HIV and tuberculosis epidemics. Clin Infect Dis. 2010;50(3):67-70. 2. World Health Organization. HIV associated Tuberculosis [Intenet]. Geneva: World Health Organization; 2016 [Cited 2017 Aug 28]. Available from: http://www.who.int/tb/areas-of-work/tb-hiv/ tbhiv_factsheet_2016_web.pdf 3. World Health Organization. Global Tuberculosis Report 2014 [Internet]. Geneva: World Health Organization; 2014 [Cited 2017 Aug 28]. Available from: http://www.who.int/tb/publications/ global_report/gtbr14_executive_summary.pdf 4. Aditama TY, Subuh M, Mustikawati DE, Surya A. Stop TB strategi nasional pengendalian TB di Indonesia 2010-2014. Jakarta: Kemenkes RI; 2011. h.12. 5. Marais BJ, Pai M. Recent advances in the diagnosis of childhood tuberculosis. Dis Child. 2007; 92(5): 446–52. 6. World Health Organization. Policy update: Automated realtime 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. Geneva: WHO; 2013. p.10-73. 7. Haris A, Maher D, Graham S. TB-HIV A clinical manual. 2nd Edition. Geneva: WHO library publishing; 2004. p.23-59. 8. Kritski A, Cataldi AA, Reyes A, Martin A, Gicquel B, Martin C, et al. Tuberculosis: from basic science to patient care, 1st Edition. Brazilia: Kamps Bourcillier, 2007. p.559-84. 9. Lawn SD, Brooks SV, Kranzer K. Screening for HIV- associated tuberculosis and rifampicin resistance before antiretroviral therapy: a prospective study. PLoS Med. 2011;8(7): e1001067. 10. Padmapriyadarsini C, Narendran G, Swaminathan S. Diagnosis and treatment of tuberculosis in HIV co-infected patients. Indian J Med Res. 2011; 134(6):850–65. 11. Chang K, Lu W, Wang J, Zhang K, Jia S, Li F, et al. Rapid and effective diagnosis of tuberculosis and rifampicin resistance with Xpert MTB/RIF assay: a meta-analysis. J Infect. 2012;64(6):580–8. 12. Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010;363(11):1005–15. 13. Hillemann D, Rusch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by the automated Gene Xpert MTB/RIF system. J Clin Microb. 2011;49(4):1202–5. 14. Malbruny B, Le Marrec G, Courageux K, Leclercq R, Cattoir V. Rapid and efficient detection of Mycobacterium tuberculosis in respiratory and non-respiratory samples. Int J Tuberc Lung Dis. 2011;15(4):553–5. 15. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1376-95. 16. Bates M, O’Grady J, Maeurer M, Tembo J, Chilukutu L, Chabala C, 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 Infect Dis. 2013;13(1): 36-42. 17. Conde MB, Soares SL, Mello FC, Rezende VM, Almeida LL, Reingold AL, et al. Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis: experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil. Am J Respir Crit Care Med. 2000;162(6):2238-40. 18. Dickson SJ, Brent A, Davidson RN, Wall R. Comparison of Bronchoscopy and gastric washings in the investigation of smear negative pulmonary tuberculosis. Clin Infect Dis. 2003;37(12):1649- 53. 19. Reid M, Shah NS. Approaches to tuberculosis screening and diagnosis in people with HIV in resource-limited settings. Lancet Infect Dis. 2009;9(3):173-84. 20. Vadwai V, Boehme C, Nabeta P, Shetty A, Alland D, Rodrigues C. Xpert MTB/RIF: a new pillar in diagnosis of extrapulmonary tuberculosis? J Clin Microbiol. 2011;49(7):2540–5. 21. World Health Organization. Rapid implementation of the Xpert MTB/RIF diagnostic test. Technical and operational ‘how-to’ practical considerations. Geneva: World Health Organization; 2011. p.5-25. 22. World Health Organization. Expert Group Meeting Report 2013. Using the Xpert MTB/RIF assay to detect pulmonary and extrapulmonary tuberculosis and rifampicin resitance in adults and children. Geneva: World Health Organization; 2013. p.2-81. 23. World Health Organization. Automated realtime 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. Geneva: World Health Organization; 2013. p.10-43. 24. Causse M, Ruiz P, Gutie´rrez-Aroca JB, Casal M. Comparison of two molecular methods for rapid diagnosis of extrapulmonary tuberculosis. J Clin Microbiol. 2011;49(8):3065–7. 25. Moure R, Martín R, Alcaide F. Effectiveness of an integrated realtime PCR method for detection of the Mycobacterium tuberculosis complex in smear-negative extrapulmonary samples in an area of low tuberculosis prevalence. J Clin Microbiol. 2012;50(2):513–5. 26. Armand S,Vanhuls P, Delcroix G, Courcol R, Lemaître N. Comparison of the Xpert MTB/RIF test with an IS6110-TaqMan Real-Time PCR Assay for direct detection of Mycobacterium tuberculosis in respiratory and non respiratory specimens. J Clin Microbiol. 2011;49(5):1772–6. 27. Tortoli E, Russo C, Piersimoni C, Mazzola E, Dal Monte P, Pascarella M, et al. Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis. Eur Respir J. 2012;40(2):442–7.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.