Evaluation of Xpert® Mycobacterium tuberculosis/rifampin in sputum-smear negative and sputum-scarce patients with pulmonary tuberculosis using bronchoalveolar lavage fluid

Content Provider	Scilit
Author	Soneja, Manish Gowda, Nikhil C. Khanna, Arjun Sinha, Sanjeev Ray, Animesh
Copyright Year	2018
Abstract	Context: Sputum smear-negative and sputum-scarce pulmonary tuberculosis (PTB) is a diagnostic challenge. $Xpert^{®}$ Mycobacterium tuberculosis/rifampin (MTB/RIF) provides a rapid diagnosis on high-quality biological specimen obtained by bronchoscopy. Aims: The aim of this study is to evaluate $Xpert^{®}$ MTB/RIF on bronchoalveolar lavage (BAL) fluid in sputum smear-negative and sputum-scarce PTB patients. Settings: Tertiary care hospital in India. Design: This was prospective observational study. Materials and Methods: Between January 2015 and November 2016, we prospectively recruited sputum-smear negative and sputum-scarce patients under evaluation for PTB and performed BAL. Sensitivity, specificity, positive, and negative predictive values were calculated for the diagnosis of PTB on BAL fluid for acid-fast bacilli smear and $Xpert^{®}$ MTB/RIF using liquid culture as the reference standard and compared to the final diagnosis based on composite reference standard. Sensitivity, specificity, and predictive values were calculated with 95% class intervals. McNemar's test was used for comparison of sensitivities. Results: Of the 60 patients included, 52 (88.3%) had a final diagnosis of PTB and 16 (26.7%) were culture confirmed. $Xpert^{®}$ MTB/RIF had a sensitivity and specificity of 81% (54%–96%) and 73% (56%–85%) in culture confirmed cases; 46% (32%–60%) and 100% (63%–100%) for the final diagnosis; 32% (17%–51%) and 100% (54%–100%) in culture negative cases, respectively. Culture had a sensitivity of 32% (20%–47%) for the final diagnosis. Conclusions: In sputum smear-negative and sputum-scarce patients with clinico-radiological features of PTB $Xpert^{®}$ MTB/RIF has good sensitivity for diagnosis on BAL fluid. It is useful even when cultures are negative.
Related Links	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034363/pdf
Ending Page	300
Page Count	6
Starting Page	295
File Format	XHTML
ISSN	09702113
e-ISSN	0974598X
DOI	10.4103/lungindia.lungindia_412_17
Journal	Lung India
Issue Number	4
Volume Number	35
Language	English
Publisher	Medknow
Access Restriction	Open
Subject Keyword	Allergy Bronchoalveolar Lavage Bronchoscopy Diagnosis Pulmonary Tuberculosis Xpert Lung India, Volume 35, Issue 4
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine