Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

  • Muhammad Mudassir Shafiq Pakistan Institute of Medical Sciences (PIMS), Islamabad
  • Muhammad Nadeem Poonch Medical College, Rawalakot AJK
  • Gul Afshan Zaidi Pakistan Institute of Medical Sciences (PIMS), Islamabad
  • Naveed Arshad Islamabad Medical and Dental College, Islamabad https://orcid.org/0000-0003-1143-8959
  • Muzammil Khan Primary and Secondary Health Department, Lahore
  • Zainab Niazi Islamabad Medical and Dental College, Islamabad
Keywords: Extra pulmonary tuberculosis, GeneXpert, Pleural biopsy, Tuberculosis

Abstract

Introduction: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of the time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis.

Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy.

Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed.

Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values. 

Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy.

Author Biographies

Muhammad Mudassir Shafiq, Pakistan Institute of Medical Sciences (PIMS), Islamabad

FCPS (Pulmonology),

Registrar

Muhammad Nadeem, Poonch Medical College, Rawalakot AJK

FCPS (Medicine),

Associate professor

Gul Afshan Zaidi, Pakistan Institute of Medical Sciences (PIMS), Islamabad

FCPS (Pulmonology),

Registrar

Naveed Arshad, Islamabad Medical and Dental College, Islamabad

M.Phil (Rehabilitation Sciences)

Assistant Professor

Muzammil Khan, Primary and Secondary Health Department, Lahore

Ph.D (Pharmaceutical Sciences)

Zainab Niazi, Islamabad Medical and Dental College, Islamabad

M.Phil (Oral pathology),

Assistant professor

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Published
2022-06-30
How to Cite
1.
Shafiq M, Nadeem M, Zaidi G, Arshad N, Khan M, Niazi Z. Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?. JRMC [Internet]. 30Jun.2022 [cited 12Aug.2022];26(2):214-8. Available from: https://journalrmc.com/index.php/JRMC/article/view/1770
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