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Free Content Comparison of molecular and immunological methods for the rapid diagnosis of smear-negative tuberculosis

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SETTING: The rapid diagnosis of pulmonary tuberculosis (TB) can be challenging if acid-fast bacilli are not detected by sputum smear microscopy.

OBJECTIVE: To compare the results of the GeneXpert® MTB/RIF assay on a single sputum or bronchoalveolar lavage (BAL) specimen test with local immunodiagnosis from the site of disease using the T-SPOT®.TB assay on BAL (BAL T-SPOT).

DESIGN: The Xpert and BAL T-SPOT tests were compared in 96 patients suspected of having sputum smear-negative pulmonary TB admitted to a referral centre in Germany.

RESULTS: BAL T-SPOT identified 10 of 11 patients with pulmonary TB (including 3/4 patients with culture-confirmed TB) with a negative Xpert test. Using Xpert, the sensitivity, specificity and positive and negative likelihood ratios (LRs) were respectively 60.0%, 97.4%, 30.0% and 0.4% in culture-confirmed cases and 42.1%, 97.4%, 21.1% and 0.6% in all TB patients. In contrast, using BAL T-SPOT, the sensitivity, specificity and positive and negative LRs were respectively 80.0%, 62.6%, 2.1% and 0.3% in culture-confirmed cases and 89.4%, 62.6%, 2.4% and 0.2% in all TB patients.

CONCLUSION: In sputum smear-negative TB suspects, a positive Xpert result is strongly indicative of culture confirmation; however, a negative result is insufficient to rule out active TB. Where clinical suspicion of pulmonary TB persists despite a negative Xpert result, local immunodiagnosis using T-SPOT on BAL may increase diagnostic accuracy.
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Keywords: BAL; GeneXpert MTB/RIF; T-SPOT.TB; TB; diagnosis

Document Type: Research Article

Affiliations: 1: Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany 2: Immune Cell-Analytics, Research Center Borstel, Borstel, Germany

Publication date: November 1, 2013

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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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