Rapid test for detection of tuberculosis and rifampin resistance

January 01, 0001

Rapid test for detection of tuberculosis and rifampin resistance

Global control of tuberculosis is hampered by slow, insensitive diagnostic methods, particularly for the detection of drug-resistant forms and in patients with human immunodeficiency virus infection. These investigators from multiple countries assessed the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), with fully integrated sample processing in 1730 patients with suspected drug-sensitive or multidrug-resistant pulmonary tuberculosis. Eligible patients in Peru, Azerbaijan, South Africa, and India provided three sputum specimens each. Two specimens were processed with N-acetyl-L-cysteine and sodium hydroxide before microscopy, solid and liquid culture, and the MTB/RIF test, and one specimen was used for direct testing with microscopy and the MTB/RIF test.

They found: "Among culture-positive patients, a single, direct MTB/RIF test identified 551 of 561 patients with smear-positive tuberculosis (98.2%) and 124 of 171 with smear-negative tuberculosis (72.5%). The test was specific in 604 of 609 patients without tuberculosis (99.2%). Among patients with smear-negative, culture-positive tuberculosis, the addition of a second MTB/RIF test increased sensitivity by 12.6 percentage points and a third by 5.1 percentage points, to a total of 90.2%. As compared with phenotypic drug- susceptibility testing, MTB/RIF testing correctly identified 200 of 205 patients (97.6%) with rifampin-resistant bacteria and 504 of 514 (98.1%) with rifampin-sensitive bacteria. Sequencing resolved all but two cases in favor of the MTB/RIF assay."

The authors concluded: "The MTB/RIF test provided sensitive detection of tuberculosis and rifampin resistance directly from untreated sputum in less than 2 hours with minimal hands-on time."

This test is promising as an advance in management of pulmonary tuberculosis.

For the full abstract, click here.

N Engl J Med 363:1005-1015, 9 September 2010
© 2010 to the Massachusetts Medical Association
Rapid Molecular Detection of Tuberculosis and Rifampin Resistance. Catharina C. Boehme, Pamela Nabeta, Doris Hillemann, et al. Correspondence to Dr. Boehme: [email protected]

Category: R. Respiratory. Keywords: tuberculosis, rifampin, sputum culture, drug resistance, molecular testing, assessment of diagnostic test, journal watch.
Synopsis edited by Dr Linda French, Toledo Ohio. Posted on Global Family Doctor 28 September 2010

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