DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20175087

GeneXpert: a game changer in the detection and diagnosis of childhood tuberculosis

Nayantara Rao Gandra, Jayasri Helen Gali

Abstract


Background: Battling against tuberculosis (TB) is still a major challenge in India, despite measures undertaken by the government and medical fraternity. Delay in diagnosing tuberculosis is a challenge, causing hurdle in the prevention of spread of the disease.

Methods: This retrospective study analysed the samples by geneXpert assay. Samples (n=403, from 359 children) included pulmonary (sputum and gastric aspirate, 359), extrapulmonary (lymph node aspirate (LNA), 41) cerebrospinal fluid (CSF, 03) pus from the lesion at the elbow joint (01).  Only sputum was analysed for 315 children, both sputum and LNA for 41.

Results: Mean age of patients was 9.08±2.85 years, range 3-15 years. There were 221 (61.56%) males and 138 (38.44%) females. Fever (71, 19.78%), fever with cough (87, 24.23%), fever with weight loss (41,11.42%) were the main symptoms.  There were three patients with high fever, headache and seizures with neck rigidity, clinically diagnosed as Tuberculous meningitis. There was history of contact with Tuberculosis in 15 (4.18%) patients. Mean ESR was 112.09mm/1st Hr±56.05 (range 54 -750 mm/1st Hr). Mantoux test was positive in 270 (75.42%). Chest X-ray was normal in 33 (9.19%); consolidation in 189 (52.65%), mild pleural effusion in 94 (26.18%) mild pleural effusion associated with consolidation in 43 (11.98%) were reported. Positive GeneXpert assay (106 samples, 27.39%; sputum (87, 24.23% %), pus (01), CSF (03), LNA (15, 57.69%) was reported in 87 patients.  Results were obtained ≤36 hours, mean 2 hours± 2.34 (range 6- 36 hours).

Conclusions: GeneXpert is an effective tool for rapid detection of tuberculosis. Present study supports its inclusion in the battery of routine investigations. It can revolutionise the scenario in prevention and management of tuberculosis. 


Keywords


GeneXpert assay, Lymph node aspirate, Rapid Detection, Sputum, Tuberculosis

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References


TB India 2017. Revised National Tuberculosis Control Programme. Annual status report. Available at http://tbcindia.gov.in/WriteReadData/TB%20India%202017.pdf. Last accessed on 6 sept 2017.

World Health Organization. Tuberculosis. Global Tuberculosis Report”, WHO, Geneva, 2016 Available at http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1. Last accessed on 22 Oct 2017

Dodd PJ, Yuen CM, Sismanidis C, Seddon JA, Jenkins HE. The global burden of tuberculosis mortality in children: a mathematical modelling study. Lancet Glob Health. 2017;5:e8898-e906.

2 million children infected by drug resistant TB. Hindustan Times, 2016 Available at www.hindustantimes.com/india-news/2-million-children-infected-by-drug-resistant-tb-study/story-010sNNxcdVMWYGgu2NNHKO.html

Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep. 2009;58:7-10.

Ioannidis P, Papaventsis D, Karabela S, Nikolaou S, Panagi M, Raftopoulou E, et al. Cepheid GeneXpert MTB/RIF Assay for Mycobacterium tuberculosis Detection and Rifampin Resistance Identification in Patients with Substantial Clinical Indications of Tuberculosis and Smear-Negative Microscopy Results . J Clin Microb. 2011;49:3068-70.

Wang SF, Ou XC, Li Q, Zheng HW, Wang YF, Zhao YL. The Abbott RealTime MTB assay and the Cepheid GeneXpert assay show comparable performance for the detection of Mycobacterium tuberculosis in sputum specimens. Int J Infect Dis. 2016;45:78-80.

Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF Assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 2011;49:4138-41.

Reechaipichitkul W, Phetsuriyawong A, Chaimanee P, Ananta P. Diagnostic test of sputum genexpert MTB/RIF for smear negative pulmonary tuberculosis. Southeast Asian J Trop Med Public Health. 2016;4:457-66.

Pandey P, Pant ND, Rijal KR, Shrestha B, Kattel S, Banjara MR, et al. Diagnostic accuracy of GeneXpert MTB/RIF assay in comparison to conventional drug susceptibility testing method for the diagnosis of multidrug-resistant tuberculosis. PLoS One. 2017;12:e0169798.

Narute S, Salgia K, Singhal P, Kalley V. Comparative study of gene Xpert MTB/RIF, smear microscopy and TB MGIT culture in diagnosis of tuberculosis in India. Euro Respir J. 2015;46: PA1533.

Sachdeva KS, Raizada N, Gupta RS, Nair SA, Denkinger C, Paramasivan CN et al. The potential impact of up-front drug sensitivity testing on india's epidemic of multi-drug resistant tuberculosis. PLoS One 2015;10:e0131438.

Tang T, Liu F, Lu X, Huang Q. Evaluation of GeneXpert MTB/RIF for detecting Mycobacterium tuberculosis in a hospital in China. J Int Med Res. 2017;45:816-22.

Shao Y, Peng H, Chen C, Zhu T, Ji M, Jiang W, et al. Evaluation of GeneXpert MTB/RIF for detection of pulmonary tuberculosis at peripheral tuberculosis clinics. Microb Pathol. 2017;105:260-3.

Dharan NJ, Blakemore R, Sloutsky A, Kaur D, Alexander RC, Ghajar M et al. Performance of the G4 Xpert® MTB/RIF assay for the detection of Mycobacterium tuberculosis and rifampin resistance: a retrospective case-control study of analytical and clinical samples from high- and low-tuberculosis prevalence settings. BMC Infect Dis. 2016;16:764.

Somily AM, Barry MA, Habib HA, Alotaibi FE, Al-Zamil FA, Khan MA, et al. Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia. Saudi Med J. 2016;37:1404-7.

Moussa HSh, Bayoumi FS, Ali AM. Evaluation of GeneXpert MTB/RIF assay for direct diagnosis of pulmonary tuberculosis Saudi Med J. 2016;37:1076-81.

Bojang AL, Mendy FS, Tientcheu LD, Otu J, Antonio M, Kampmann B, et al. Comparison of TB-LAMP, GeneXpert MTB/RIF and culture for diagnosis of pulmonary tuberculosis in The Gambia. J Infect. 2016;72:332-7.

Bajrami R, Mulliqi G, Kurti A, Lila G, Raka L. Comparison of GeneXpert MTB/RIF and conventional methods for the diagnosis of tuberculosis in Kosovo. J Infec Develop Countries. 2016;10:418-22.

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;363:1005-15.

Boehme CC1, Nicol MP, Nabeta P, Michael JS, Gotuzzo E, Tahirli R, et al. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet. 2011;377:1495-505.

Diallo AB, Kollo AI, Camara M, Lo S, Ossoga GW, Mbow M et al. Performance of GeneXpert MTB / RIF® in the diagnosis of extrapulmonary tuberculosis in Dakar: 2010-2015. Pan Afr Med J 2016;25:129.

Pandey S, Congdon J, McInnes B, Pop A, Coulter C. Evaluation of the GeneXpert MTB/RIF assay on extrapulmonary and respiratory samples other than sputum: a low burden country experience. Pathol. 2017;49:70-4

Chen ZF, Lao HL, Li XH, Wang J, Chen Q, Wang ZX, Wang DC. Experimental study of GeneXpert (®) system in the diagnosis of extra-pulmonary tuberculosis. Chinese J Tubercul Respir Dis. 2016;39(7):529-33.

Ghariani A, Jaouadi T, Smaoui S, Mehiri E, Marouane C, Kammoun S, et al. Diagnosis of lymph node tuberculosis using the GeneXpert MTB/RIF in Tunisia. Int J Mycobacteriol 2015;4:270-5

Tadesse M, Abebe G, Abdissa K, Aragaw D, Abdella K, Bekele A, et al. GeneXpert MTB/RIF Assay for the diagnosis of tuberculous lymphadenitis on concentrated fine needle aspirates in high tuberculosis burden settings. PLoS One. 2015;10:e0137471.

Hillemann D, Rüsch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF System. J Clin Microbiol. 2011;49:1202-5.

Singh UB, Pandey P, Mehta G, Bhatnagar AK, Mohan A, Goyal V, et al. Genotypic, phenotypic and clinical validation of GeneXpert in extra-pulmonary and pulmonary tuberculosis in India. PLoS One. 2016;11:e0149258.

Habte D, Melese M, Hiruy N, Gashu Z, Jerene D, Moges F, et al. The additional yield of GeneXpert MTB/RIF test in the diagnosis of pulmonary tuberculosis among household contacts of smear positive TB cases. Int J Infect Dis. 2016;49:179-84.

Khan SU, Rahman H, Ayaz S, Qasim M, Jabbar A, Khurshid M, et al. GeneXpert assay for rapid detection of Mycobacterium tuberculosis complex in respiratory specimens from a high TB endemic area of Pakistan. Microb Pathol. 2016;95:82-5.

Marouane C, Smaoui S, Kammoun S, Slim L, Messadi-Akrout F. Evaluation of molecular detection of extrapulmonary tuberculosis and resistance to rifampicin with GeneXpert® MTB/RIF. Med Mal Infect. 2016;46:20-4.

Bunsow E, Ruiz-Serrano MJ, López Roa P, Kestler M, Viedma DG, Bouza E. Evaluation of GeneXpert MTB/RIF for the detection of Mycobacterium tuberculosis and resistance to rifampin in clinical specimens. J Infect. 2014;68:338-43.

Centres for disease control and prevention (CDC). Availability of an assay for detecting Mycobacterium tuberculosis, including rifampin-resistant strains, and considerations for its use - United States, 2013. MMWR Morb Mortal Wkly Rep. 2013;62:821-7.

Raizada N, Sachdeva KS, Sreenivas A, Vadera B, Gupta RS, Parmar M et al. Feasibility of decentralised deployment of Xpert MTB/RIF test at lower level of health system in India. PLoS One. 2014 Feb 26;9(2):e89301.