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Current Pharmaceutical Biotechnology

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ISSN (Print): 1389-2010
ISSN (Online): 1873-4316

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Research Article

The Application of Xpert Mycobacterium tuberculosis/Rifampicin, Quantitative Polymerase Chain Reaction and High Resolution Melting Curve in the Diagnosis of Superficial Lymph Node TB.

Author(s): Yi Han, Ning Xiao, Shaojung Huang, Ming Qin , Nanying Che* and Zhidong Liu*

Volume 20, Issue 12, 2019

Page: [1044 - 1054] Pages: 11

DOI: 10.2174/1389201020666190716104131

Price: $65

Abstract

Objective: The diagnostic sensitivity and specificity of conventional methods for superficial lymph node tuberculosis (LNTB) are not ideal. We evaluated several novel methods including Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF) technology, quantitative fluorescence Polymerase Chain Reaction (qPCR) and High-Resolution Melting Curve (HRMC) in the diagnosis of superficial lymph node TB.

Methods: Specimens from eighty-one consecutive patients with suspected LNTB and thirteen cases with other lymph node disease were analyzed by Xpert MTB/RIF, qPCR, and HRMC.

Results: Among 81 patients with clinical suspicion of LNTB, there were 74 (91.4%) cases positive Mycobacterium tuberculosis Complex (MTBC) of Xpert MTB/RIF, 60 (74%) positive of qPCR, 24 (29.6%) of positive of BACTEC MGIT960 culture, and 13 (16%) cases positive of Roche culture. 38 cases (46.9%) were diagnosed with LNTB. All test methods showed a diagnostic specificity of 100% for LNTB. The sensitivity of molecular biology techniques was significantly higher than that of the traditional diagnostic methods, and Xpert MTB/RIF was the most sensitive diagnostic assay. On Rifampinresistant detection, Xpert MTB/RIF detected three cases (3.7%) with rpoB gene mutation, and Mycobacterium tuberculosis susceptibility testing detected 2 rifampicin-resistant cases (2.4%) which were consistent with Xpert MTB/RIF results. In the Isoniazid-resistant, 7 cases (8.1) of isoniazid resistance mutations (8.1%) were detected by HNC and 1 case was confirmed by Isoniazid susceptibility test.

Conclusion: Molecular detection increased the diagnostic sensitivity of LNTB and improved the detection sensitivity for rifampin and isoniazid resistance strain.

Keywords: Lymph node TB, Xpert MTB/RIF, Rifampin, isoniazid, resistance, High-Resolution Melting Curve (HRMC).

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[1]
Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2016; World Health Organization: Geneva, 2018.
[2]
Organization, WH Organization WH. Global tuberculosis report 2016,, 2016.
[3]
Lawn, S.D.; Mwaba, P.; Bates, M.; Piatek, A.; Alexander, H.; Marais, B.J.; Cuevas, L.E.; McHugh, T.D.; Zijenah, L.; Kapata, N.; Abubakar, I.; McNerney, R.; Hoelscher, M.; Memish, Z.A.; Migliori, G.B.; Kim, P.; Maeurer, M.; Schito, M.; Zumla, A. Advances in tuberculosis diagnostics: The Xpert MTB/RIF assay and future prospects for a point-of-care test. Lancet Infect. Dis., 2013, 13(4), 349-361.
[http://dx.doi.org/10.1016/S1473-3099(13)70008-2] [PMID: 23531388]
[4]
Gilad, J.; Borer, A.; Riesenberg, K.; Peled, N.; Schlaeffer, F. Epidemiology and ethnic distribution of multidrug-resistant tuberculosis in southern Israel, 1992-1997: The impact of immigration. Chest, 2000, 117(3), 738-743.
[http://dx.doi.org/10.1378/chest.117.3.738] [PMID: 10713000]
[5]
Hesselink, D.A.; Yoo, S.M.; Verhoeven, G.T.; Brouwers, J.W.; Smit, F.J.; van Saase, J.L. A high prevalence of culture-positive extrapulmonary tuberculosis in a large Dutch teaching hospital. Neth. J. Med., 2003, 61(3), 65-70.
[PMID: 12765226]
[6]
Kanlikama, M.; Mumbuç, S.; Bayazit, Y.; Sirikçi, A. Management strategy of mycobacterial cervical lymphadenitis. J. Laryngol. Otol., 2000, 114(4), 274-278.
[http://dx.doi.org/10.1258/0022215001905544] [PMID: 10845042]
[7]
Weir, M.R.; Thornton, G.F. Extrapulmonary tuberculosis. Experience of a community hospital and review of the literature. Am. J. Med., 1985, 79(4), 467-478.
[http://dx.doi.org/10.1016/0002-9343(85)90034-8] [PMID: 4050833]
[8]
Raviglione, M.; Marais, B.; Floyd, K.; Lönnroth, K.; Getahun, H.; Migliori, G.B.; Harries, A.D.; Nunn, P.; Lienhardt, C.; Graham, S.; Chakaya, J.; Weyer, K.; Cole, S.; Kaufmann, S.H.; Zumla, A. Scaling up interventions to achieve global tuberculosis control: Progress and new developments. Lancet, 2012, 379(9829), 1902-1913.
[http://dx.doi.org/10.1016/S0140-6736(12)60727-2] [PMID: 22608339]
[9]
Boehme, C.C.; Nabeta, P.; Hillemann, D.; Nicol, M.P.; Shenai, S.; Krapp, F.; Allen, J.; Tahirli, R.; Blakemore, R.; Rustomjee, R.; Milovic, A.; Jones, M.; O’Brien, S.M.; Persing, D.H.; Ruesch-Gerdes, S.; Gotuzzo, E.; Rodrigues, C.; Alland, D.; Perkins, M.D. Rapid molecular detection of tuberculosis and rifampin resistance. N. Engl. J. Med., 2010, 363(11), 1005-1015.
[http://dx.doi.org/10.1056/NEJMoa0907847] [PMID: 20825313]
[10]
Denkinger, C.M.; Schumacher, S.G.; Boehme, C.C.; Dendukuri, N.; Pai, M.; Steingart, K.R. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: A systematic review and meta-analysis. Eur. Respir. J., 2014, 44(2), 435-446.
[http://dx.doi.org/10.1183/09031936.00007814] [PMID: 24696113]
[11]
Handa, U.; Mundi, I.; Mohan, S. Nodal tuberculosis revisited: A review. J. Infect. Dev. Ctries., 2012, 6(1), 6-12.
[http://dx.doi.org/10.3855/jidc.2090] [PMID: 22240421]
[12]
Yan, J-J.; Huang, A-H.; Tsai, S-H.; Ko, W-C.; Jin, Y-T.; Wu, J-J. Comparison of the MB/BacT and BACTEC MGIT 960 system for recovery of mycobacteria from clinical specimens. Diagn. Microbiol. Infect. Dis., 2000, 37(1), 25-30.
[http://dx.doi.org/10.1016/S0732-8893(00)00118-8] [PMID: 10794936]
[13]
Atlas‐Ronald, M. Handbook of Microbiological Media. In: CRC Press, 3rd ed; Boca Raton, FL. , 2004.
[http://dx.doi.org/10.1201/9781420039726]
[14]
Kent, P.T.; Kubica, G.P. Public Health Mycobacteriology: A Guide for Level III Laboratory. In: US Department of Health and Human Services, Public Health Service, Centers for Disease Control; Atlanta, GA, 1985.
[15]
Boehme, C.C.; Nicol, M.P.; Nabeta, P.; Michael, J.S.; Gotuzzo, E.; Tahirli, R.; Gler, M.T.; Blakemore, R.; Worodria, W.; Gray, C.; Huang, L.; Caceres, T.; Mehdiyev, R.; Raymond, L.; Whitelaw, A.; Sagadevan, K.; Alexander, H.; Albert, H.; Cobelens, F.; Cox, H.; Alland, D.; Perkins, M.D. 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(9776), 1495-1505.
[http://dx.doi.org/10.1016/S0140-6736(11)60438-8] [PMID: 21507477]
[16]
Heifets, L. Conventional methods for antimicrobial susceptibility testing of Mycobacterium tuberculosis. Multidrug-resistant Tuberculosis; Bastian, I; Portaels, F., Ed.; Kluwer Academic Publishers: Dordrecht, The Netherlands, 2000, pp. 133-143.
[http://dx.doi.org/10.1007/978-94-011-4084-3_8]
[17]
Chakravorty, S.; Simmons, A.M.; Rowneki, M.; Parmar, H.; Cao, Y.; Ryan, J.; Banada, P.P.; Deshpande, S.; Shenai, S.; Gall, A.; Glass, J.; Krieswirth, B.; Schumacher, S.G.; Nabeta, P.; Tukvadze, N.; Rodrigues, C.; Skrahina, A.; Tagliani, E.; Cirillo, D.M.; Davidow, A.; Denkinger, C.M.; Persing, D.; Kwiatkowski, R.; Jones, M.; Alland, D. The new Xpert MTB/RIF Ultra: Improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. MBio, 2017, 8(4), e00812-e00817.
[http://dx.doi.org/10.1128/mBio.00812-17] [PMID: 28851844]
[18]
Lawn, S.D.; Zumla, A.I. Diagnosis of extrapulmonary tuberculosis using the Xpert(®) MTB/RIF assay. Expert Rev. Anti Infect. Ther., 2012, 10(6), 631-635.
[http://dx.doi.org/10.1586/eri.12.43] [PMID: 22734954]
[19]
Biadglegne, F.; Mulu, A.; Rodloff, A.C.; Sack, U. Diagnostic performance of the Xpert MTB/RIF assay for tuberculous lymphadenitis on fine needle aspirates from Ethiopia. Tuberculosis (Edinb.), 2014, 94(5), 502-505.
[http://dx.doi.org/10.1016/j.tube.2014.05.002] [PMID: 24931451]
[20]
Naaktgeboren, C.A.; Bertens, L.C.; van Smeden, M.; de Groot, J.A.; Moons, K.G.; Reitsma, J.B. Value of composite reference standards in diagnostic research. BMJ, 2013, 347, f5605.
[http://dx.doi.org/10.1136/bmj.f5605] [PMID: 24162938]
[21]
Scott, L.E.; Beylis, N.; Nicol, M.; Nkuna, G.; Molapo, S.; Berrie, L.; Duse, A.; Stevens, W.S. Diagnostic accuracy of Xpert MTB/RIF for extrapulmonary tuberculosis specimens: Establishing a laboratory testing algorithm for South Africa. J. Clin. Microbiol., 2014, 52(6), 1818-1823.
[http://dx.doi.org/10.1128/JCM.03553-13] [PMID: 24622091]
[22]
Dendukuri, N.; Schiller, I.; Joseph, L.; Pai, M. Bayesian meta-analysis of the accuracy of a test for tuberculous pleuritis in the absence of a gold standard reference. Biometrics, 2012, 68(4), 1285-1293.
[http://dx.doi.org/10.1111/j.1541-0420.2012.01773.x] [PMID: 22568612]
[23]
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(4), 1202-1205.
[http://dx.doi.org/10.1128/JCM.02268-10] [PMID: 21270230]
[24]
Iwnetu, R.; van den Hombergh, J.; Woldeamanuel, Y.; Asfaw, M.; Gebrekirstos, C.; Negussie, Y.; Bekele, T.; Ashenafi, S.; Seyoum, B.; Melaku, K.; Yamuah, L.; Tilahun, H.; Tadesse, Z.; Aseffa, A. Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country. Scand. J. Infect. Dis., 2009, 41(6-7), 462-468.
[http://dx.doi.org/10.1080/00365540902897697] [PMID: 19382003]
[25]
Bozzano, F.; Marras, F.; De Maria, A. Immunology of tuberculosis. Mediterr. J. Hematol. Infect. Dis., 2014, 6(1)e2014027
[http://dx.doi.org/10.4084/mjhid.2014.027] [PMID: 24804000]
[26]
Banada, P.P.; Sivasubramani, S.K.; Blakemore, R.; Boehme, C.; Perkins, M.D.; Fennelly, K.; Alland, D. Containment of bioaerosol infection risk by the Xpert MTB/RIF assay and its applicability to point-of-care settings. J. Clin. Microbiol., 2010, 48(10), 3551-3557.
[http://dx.doi.org/10.1128/JCM.01053-10] [PMID: 20720033]
[27]
Feasey, N.A.; Banada, P.P.; Howson, W.; Sloan, D.J.; Mdolo, A.; Boehme, C.; Chipungu, G.A.; Allain, T.J.; Heyderman, R.S.; Corbett, E.L.; Alland, D. Evaluation of Xpert MTB/RIF for detection of tuberculosis from blood samples of HIV-infected adults confirms Mycobacterium tuberculosis bacteremia as an indicator of poor prognosis. J. Clin. Microbiol., 2013, 51(7), 2311-2316.
[http://dx.doi.org/10.1128/JCM.00330-13] [PMID: 23678061]
[28]
Helb, D.; Jones, M.; Story, E.; Boehme, C.; Wallace, E.; Ho, K.; Kop, J.; Owens, M.R.; Rodgers, R.; Banada, P.; Safi, H.; Blakemore, R.; Lan, N.T.; Jones-López, E.C.; Levi, M.; Burday, M.; Ayakaka, I.; Mugerwa, R.D.; McMillan, B.; Winn-Deen, E.; Christel, L.; Dailey, P.; Perkins, M.D.; Persing, D.H.; Alland, D. Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J. Clin. Microbiol., 2010, 48(1), 229-237.
[http://dx.doi.org/10.1128/JCM.01463-09] [PMID: 19864480]

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