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GeneXpert MTB/RIF assay for the diagnosis of tuberculous lymphadenitis on concentrated fine needle aspirates in high tuberculosis burden settings

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dc.contributor.author Tadesse, M.
dc.contributor.author Abebe, G.
dc.contributor.author Abdissa, K.
dc.contributor.author Aragaw, D.
dc.contributor.author Abdella, K.
dc.contributor.author Bekele, A.
dc.contributor.author Bezabih, M.
dc.contributor.author Apers, L.
dc.contributor.author de Jong, B. C.
dc.contributor.author Rigouts, L.
dc.date.accessioned 2016-03-11T10:22:27Z
dc.date.available 2016-03-11T10:22:27Z
dc.date.issued 2015
dc.identifier.issn 1932-6203
dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0137471
dc.identifier.other ITG-C8A
dc.identifier.other ITG-B9A
dc.identifier.other ITG-BLA
dc.identifier.other MULTI
dc.identifier.other DCS
dc.identifier.other U-STDCLI
dc.identifier.other DBM
dc.identifier.other U-MYCOB
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other FTA
dc.identifier.other OAJ
dc.identifier.other Abstract
dc.identifier.other UPD60
dc.identifier.uri http://hdl.handle.net/10390/8729
dc.description.abstract INTRODUCTION: The diagnosis of tuberculous lymphadenitis (TBL) remains challenging. The routinely used methods (cytology and smear microscopy) have sub-optimal sensitivity. Recently, WHO recommends GeneXpert to be used as the initial diagnostic test in patients suspected of having extra-pulmonary tuberculosis (EPTB). However, this was a conditional recommendation due to very low-quality evidence available and more studies are needed. In this study we evaluated the performance of Xpert for the diagnosis of TBL on concentrated fine needle aspirates (FNA) in Southwest Ethiopia. METHODS: FNA was collected from presumptive TBL cases. Two smears were prepared from each aspirate and processed for cytology and conventional microscopy. The remaining aspirate was treated with N-acetyl-L-cysteine-NaOH and centrifuged for 15minutes at 3000g. The concentrated sediment was used for culture and Xpert test. Capilia TB-Neo test was used to differentiate M. tuberculosis complex (MTBC) from non-tuberculous mycobacteria (NTM). Composite bacteriological methods (culture and/or smear microscopy) were considered as a reference standard. RESULT: Out of 143 enrolled suspects, 64.3% (92/143) were confirmed TBL cases by the composite reference standard (CRS). Xpert detected M. tuberculosis complex (MTBC) in 60.1% (86/143) of the presumptive TBL cases. The sensitivity of Xpert compared to CRS was 87.8% [95% CI: 81.0-94.5] and specificity 91.1% [95% CI: 82.8-99.4]. The sensitivity was 27.8% for smear microscopy and 80% for cytology compared to CRS. Cytology showed the lowest specificity (57.8%). Xpert was positive in 4 out of 45 culture- and smear-negative cases. Among 47 cytomorphologically non-TBL cases, 15 were positive on Xpert. More than half of Xpert-positive cases were in the range of very low cut-off threshold values (28<Ct<38). Resistance to rifampicin was identified in 4.7% (4/86) of Xpert-positive cases. CONCLUSION: Xpert test showed a high sensitivity and specificity for the diagnosis of TBL on concentrated FNA samples. In addition, Xpert offered rapid detection of rifampicin-resistant M. tuberculosis strains from lymph node aspirates. en_US
dc.language English en_US
dc.subject Bacterial diseases en_US
dc.subject Extra-pulmonary en_US
dc.subject Tuberculosis en_US
dc.subject Mycobacterium tuberculosis complex en_US
dc.subject Lymphadenitis en_US
dc.subject Evaluation en_US
dc.subject Performance en_US
dc.subject Fine-needle aspiration en_US
dc.subject Diagnosis en_US
dc.subject Cytology en_US
dc.subject Microscopy en_US
dc.subject Specificity en_US
dc.subject Sensitivity en_US
dc.subject Detection en_US
dc.subject Ethiopia en_US
dc.subject Africa, East en_US
dc.title GeneXpert MTB/RIF assay for the diagnosis of tuberculous lymphadenitis on concentrated fine needle aspirates in high tuberculosis burden settings en_US
dc.type Article-E en_US
dc.citation.issue 9 en_US
dc.citation.jtitle PLoS ONE en_US
dc.citation.volume 10 en_US
dc.citation.pages e0137471 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/26366871
dc.citation.jabbreviation PLoS ONE en_US


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