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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2014, Number 3

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Rev Mex Patol Clin Med Lab 2014; 61 (3)

Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and rifampin resistance in extrapulmonary specimens

Barriga AG, Solís TM, Aceves RA, López ÁL, Ramírez CF, Monzalvo HME, Hernández SEA, Arumir EC

Language: Spanish
References: 23
Page: 140-144
PDF size: 130.62 Kb.


ABSTRACT

Introduction: In most cases of extrapulmonary tuberculosis, its etiological diagnosis is very seldom acomplished. The meningeal form of tuberculosis requires an early diagnosis and treatment because of its high rate of mortality and neurological sequelae. In this study, we report the results obtained with the use of a polymerase chain reaction and rifampin resistance technique (GeneXpert MTB/RIF)TM in 693 patients with the presuntive diagnosis of extrapulmonary tuberculosis, in comparison with the conventional techniques of stains, culture, tipification and antimicrobial susceptibility. Material and methods: We make a retrospective analysis of the results obtained in 693 samples of the same number of patients with presuntive clinical diagnosis of tuberculosis using the Ziehl-Neelsen stain technique, two culture media: Lowestein Jensen (BioMerieux) and Middlebrook broth base 7H9 (MGIT Becton Dickinson), two tipification techniques: Gen Probe (Accuprobe), Genotype MTBRD (Hain Lifescience), two antimicrobial susceptibility methods: Genotype MTBRD (Hain Lifescience), MGIT (Becton Dickinson) and a rapid technique of polymerase chain reaction and rifampin resistance (GeneXpert MTB/RIF (Cepheid), in the lapse of five years. Results: Most of the samples studied correspond to CSF and pleural effusions. 101 samples were positive by culture. 74 of the isolations correspond to the Mycobacterium tuberculosis complex, 22 to Mycobacterium avium, and five to Mycobacterium kansasii. The most sensitive method was the culture in the MGIT medium (86.12%), followed by the technique of GeneXpert (73.2%). None of the strains of Mycobacterium tuberculosis complex showed resistance to rifampin or to the other antimicrobials studied. The mean time for the obtention of a positive result was 34 days for the culture in the Lowestein Jensen media,14 for the MGIT media, and 2.5 hours for the GeneXpert test. Conclusions: The GeneXpert MTB/RIF TestTM used in the study of 693 patients with the presuntive diagnosis of extrapulmonary tuberculosis showed numerous advantages over the conventional techniques: shorter time of obtention of results (hours versus days). High sensitivity (73.2%) and specificity (100%) –its sensitivity, considering only the isolations of Mycobacterium tuberculosis complex, was 100%–, the additional determination of rifampin resistance, and its technical simplicity. Its disadvantages were: no detection of strains other than the Mycobacterium tuberculosis complex (26.8% of the cases) and its high cost.


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