Evaluation of Cepheid’s Xpert MTB/RIF Test on Pleural Fluid in the Diagnosis of Pleural Tuberculosis in a High Prevalence HIV/TB Setting
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Diagnosis of pleural tuberculosis (TB) using routinely available diagnostic methods is challenging due to the
paucibacillary nature of the disease. Histopathology and pleural tissue TB culture involves an invasive procedure which
requires expertise and appropriate equipment, both often unavailable in many health units. Xpert MTB/Rif test has been
widely evaluated in sputum specimens but data on its performance in pleural TB is scarce. We evaluated the accuracy of
Cepheid’s Xpert MTB/Rif test on pleural fluid in the diagnosis of pleural TB in Uganda.
Methods: Consenting adult patients with exudative pleural effusions underwent pleural biopsy and the tissue obtained
subjected to Lowenstein-Jensen and mycobacterial growth indicator tube MTB cultures and histopathology. Pleural fluid for
Xpert MTB/Rif testing was also collected. Data on socio-demographic characteristics, clinical symptoms, HIV status and CD4
count were also collected. Sensitivity, specificity, positive and negative predictive values of Xpert MTB/Rif test on pleural
fluid in pleural TB diagnosis were calculated using pleural tissue MTB culture and/or histopathology as the reference
standard.
Results: Of the 116 participants [female 50%, mean age 34 (SD 613], 87/116 (75%) had pleural TB confirmed on pleural
tissue culture and/or histopathology. The Xpert MTB/Rif test identified 25 (28.7%) of the 87 confirmed pleural TB cases. The
sensitivity and specificity of Xpert MTB/Rif test were 28.7% and 96.6% respectively while the positive and negative
predictive values were 96.1% and 31.1% respectively.
Conclusion: Xpert MTB/Rif test on pleural fluid does not accurately diagnose pleural TB and therefore cannot be used as an
initial evaluation test in patients with suspected pleural TB. New, rapid and accurate tests for the diagnosis of pleural TB are
still warranted.
Description
Keywords
Evaluation, Cepheid’s Xpert MTB/RIF Test, Pleural Fluid, Pleural Tuberculosis
Citation
Lusiba JK, Nakiyingi L, Kirenga BJ, Kiragga A, Lukande R, et al. (2014) Evaluation of Cepheid’s Xpert MTB/RIF Test on Pleural Fluid in the Diagnosis of Pleural Tuberculosis in a High Prevalence HIV/TB Setting. PLoS ONE 9(7): e102702. doi:10.1371/journal.pone.0102702