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Rifampicin susceptibility discordance between Xpert MTB/RIF G4 and Xpert Ultra before MDRT-TB treatment initiation: a case report from Uganda Instituut voor Tropische Geneeskunde

Willy Ssengooba, Kevin Komakech, Sharon Namiiro, Henry Byabajungu, Joanitah Nalunjogi, Winceslaus Katagira, Ivan Kimuli, Moses L Joloba, Susan Adakun, Lydia Nakiyingi, et al.

Tuberculosis (TB) resistance to rifampicin, the most powerful drug leads to increase in mortality. Globally, half a million new patients develop such resistant TB each year, coupled with both inappropriate diagnosis and treatment initiation.

We report a case of rifampicin resistant Mycobacterium tuberculosis whose rifampicin resistance was missed by Xpert MTB/RIF Assay G4 but detected by the Xpert MTB/RIF Ultra assay at different time ...

Improving pediatric TB diagnosis in North Kivu (DR Congo), focusing on a clinical algorithm including targeted Xpert MTB/RIF on gastric aspirates Universiteit Gent

Daan Van Brusselen, Erica Simons, Tony Luendo, Delphine Habarugira, Jimmy Ngowa, Nadine Neema Mitutso, Zakari Moluh, Mieke Steenssens, Rachelle Seguin, Hilde Vochten, et al.
Background The incidence of tuberculosis (TB) in the Democratic Republic of the Congo (DRC) is 323/100,000. A context of civil conflict, internally displaced people and mining activities suggests a higher regional TB incidence in North Kivu. Medecins Sans Frontieres (MSF) supports the General Reference Hospital of Masisi, North Kivu, covering a population of 520,000, with an elevated rate of pediatric malnutrition. In July 2017, an adapted MSF ...

Systematic screening for drug-resistant tuberculosis with Xpert (R) MTB/RIF in a referral hospital in Cambodia KU Leuven Universiteit Antwerpen Instituut voor Tropische Geneeskunde

Natalie Lorent
SETTING: Limited access to drug susceptibility testing (DST) in referral hospitals contributes to delayed detection of multidrug-resistant tuberculosis (MDR-TB). OBJECTIVE: To document the impact of identifying rifampicin (RMP) resistance using Xpert(®) MTB/RIF on time to diagnosis and time to treatment, and evaluate its performance under programmatic conditions. METHODS: Using a prospective observational study, we screened presumptive MDR-TB ...

Case report of a false positive result of the Xpert MTB/RIF assay for rifampicin resistance in Mycobacterium tuberculosis complex KU Leuven

Inge Derdelinckx
In the present case, we report a false positive result for the detection of rifampicin (RIF) resistance by the Xpert® MTB/RIF assay, version G4.Miliary Mycobacterium tuberculosis infection (miliary TB) was suspected in a 50-year old Angolan woman. Imaging of the thorax and abdomen displayed diffuse lesions. The Xpert® MTB/RIF assay conducted on the broncho-alveolar lavage (BAL) fluid was positive for TB and positive for RIF resistance. ...

Xpert (R) MTB/RIF for point-of-care diagnosis of TB in high-HIV burden, resource-limited countries Universiteit Antwerpen

Annelies Van Rie, Liesl Page-Shipp, Lesley Scott, Ian Sanne, Wendy Stevens
Despite the identification of Mycobacterium tuberculosis as the cause of tuberculosis (TB) more than a century ago, diagnosing TB in resource-poor countries remains a challenge, especially in people living with HIV. In the past decade, important research investments have been made towards the development of new diagnostics for TB and the Xpert (R) MTB/RIF assay (Cepheid, CA, USA) has emerged as one of the most promising. In this article, we ...

The value of lateral flow urine lipoarabinomannan assay and empirical treatment in Xpert MTB/RIF ultra negative patients with presumptive TB Universiteit Antwerpen

Wakjira Kebede, Gemeda Abebe, Esayas Kebede Gudina, Annelies Van Rie
The value of Lateral Flow urine Lipoarabinomannan (LF-LAM) assay and the role of empiric tuberculosis (TB) treatment in the era of the highly sensitive Xpert MTB/RIF Ultra (Xpert Ultra) assay is unclear. This study aimed to assess the additional yield of LF-LAM assay when used in combination with Xpert Ultra, and the role of empiric TB treatment when Xpert Ultra used as the initial diagnostic in presumptive TB cases admitted to a tertiary ...

Prevalence and drivers of false-positive rifampicin-resistant Xpert MTB/RIF results: a prospective observational study in Rwanda Instituut voor Tropische Geneeskunde Universiteit Antwerpen

Jean Claude Semuto Ngabonziza, Tom Decroo, Patrick Migambi, Yves Mucyo Habimana, Armand Van Deun, Conor Meehan, Gabriela Torrea, Faridath Massou, Willem Bram de Rijk, Bertin Ushizimpumu, et al.

Background The Xpert MTB/RIF (Xpert) assay is used globally to rapidly diagnose tuberculosis and resistance to rifampicin. We investigated the frequency and predictors of false-positive findings of rifampicin resistance with Xpert.

Methods We did a prospective, observational study of individuals who were enrolled in a Rwandan nationwide diagnostic cohort study (DIAMA trial; NCT03303963). We included patients identified to have ...

Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a diagnostic evaluation study Universiteit Antwerpen Instituut voor Tropische Geneeskunde

Mulualem Tadesse Jano, G. Abebe, A. Bekele, M. Bezabih, D. Yilma, L. Apers, B. C. de Jong, Leen Rigouts
Objectives: The diagnosis of extrapulmonary tuberculosis (EPTB) is often made on clinical suspicion alone, resulting in both under-and overdiagnosis and relatively poor outcomes. In this study, we evaluated the clinical utility of the Xpert MTB/RIF on routinely collected extrapulmonary specimens in Ethiopia. Methods: This study was carried out at Jimma University Specialized Hospital, Southwest Ethiopia. Extrapulmonary specimens were collected ...

Comparison of Xpert MTB/RIF with other nucleic acid technologies for diagnosing pulmonary tuberculosis in a high HIV prevalence setting Universiteit Antwerpen

Lesley E. Scott, Kerrigan McCarthy, Natasha Gous, Matilda Nduna, Annelies Van Rie, Ian Sanne, Willem F. Venter, Adrian Duse, Wendy Stevens
Background: The Xpert MTB/RIF (Cepheid) non-laboratory-based molecular assay has potential to improve the diagnosis of tuberculosis (TB), especially in HIV-infected populations, through increased sensitivity, reduced turnaround time (2 h), and immediate identification of rifampicin (RIF) resistance. In a prospective clinical validation study we compared the performance of Xpert MTB/RIF, MTBDRplus (Hain Lifescience), LightCycler Mycobacterium ...

Accuracy of lipoarabinomannan and Xpert MTB/RIF testing in cerebrospinal fluid to diagnose tuberculous meningitis in an autopsy cohort of HIV-infected adults Instituut voor Tropische Geneeskunde Universiteit Gent Universiteit Antwerpen

Janneke Cox, Robert L Lukande, Sam Kalungi, Eric Van Marck, Martin Lammens, Koen Van de Vijver, Andrew Kambugu, Ann M Nelson, Robert Colebunders, Yukari C Manabe, et al.

Point-of-care tests for tuberculous meningitis (TBM) are needed. We studied the diagnostic accuracy of the lipoarabinomannan (LAM) lateral flow assay (LFA), LAM enzyme-linked immunosorbent assay (ELISA), and Xpert MTB/RIF in cerebrospinal fluid (CSF) in an autopsy cohort of Ugandan HIV-infected adults. We obtained written informed consent postmortem from the next of kin. A complete autopsy was done and CSF obtained. We performed LAM LFA (on ...