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Free Content False-positive rifampicin resistance on Xpert® MTB/RIF: case report and clinical implications [Technical note]

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The World Health Organization had endorsed Xpert® MTB/RIF (Xpert) as the initial diagnostic for multidrug-resistant tuberculosis (TB) or TB suspects co-infected with the human immunodeficiency virus. We investigated an unexpected case of rifampicin (RMP) resistance on Xpert using repeat Xpert, smear microscopy, MTBDRplus assay, culture, drug susceptibility testing, spoligotyping and rpoB gene sequencing. A false-positive result was most likely, given the wild type rpoB gene sequence and exclusion of both mixed infection and mixture of drug-susceptible and drug-resistant populations. When decentralising Xpert, test performance characteristics need to be understood by health care workers and methods of confirmation of RMP resistance need to be accessible.
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Keywords: MDR-TB; assay performance; false-positive rifampicin resistance; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA 2: Right to Care, Johannesburg, South Africa 3: Clinical Microbiology and Infectious Diseases, University of Witwatersrand, Johannesburg, South Africa; and National Health Laboratory Services, Johannesburg, South Africa 4: National Health Laboratory Services, Johannesburg, South Africa; and Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa 5: Witkoppen Health and Welfare Centre, Fourways, Gauteng, South Africa 6: Department of Science and Technology, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa

Publication date: February 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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