Xpert MTB/RIF for diagnosis of tuberculous cervical lymphadenitis in HIV-infected patients.

Abstract

OBJECTIVES/HYPOTHESIS:

The World Health Organization endorsed the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis (TB), but there is limited information about the utility of this assay for the diagnosis of TB lymphadenitis. Therefore, the objective of this study was to assess the diagnostic accuracy of Xpert MTB/RIF assay in HIV-infected patients with palpable cervical lymph nodes.

STUDY DESIGN:

Prospective, diagnostic test study.

METHODS:

Consecutive patients with cervical lymphadenopathy were prospectively enrolled between January 2011 and March 2013. Lymph node specimens were obtained through fine-needle aspiration or excisional biopsy. Mycobacterial culture was considered as the gold standard.

RESULTS:

Mycobacterium TB was cultured from 15 of 68 specimens (22.05%), and 53 specimens had negative cultures (77.94%). The sensitivity of Xpert MTB/RIF was 100% (95% CI, 74.65%-100%), and the specificity was 100% (95% CI, 91.58%-100%). Smear microscopy had a lower diagnostic performance.

CONCLUSION:

Although based on a limited sample size, our study indicates that Xpert MTB/RIF is a useful method for the diagnosis of cervical TB lymphadenitis in HIV-infected patients, regardless of the bacillary load in smear-positive samples or the CD4 T cell count. The sensitivity, specificity, positive predictive value, and negative predictive value were similar to gold-standard culture.

LEVEL OF EVIDENCE:

N/A.

• Authors: Yuria Ablanedo-Terrazas, Claudia Alvarado-de la Barrera, Ramón Hernández-Juan, Matilde Ruiz-Cruz, Gustavo Reyes-Terán
• Journal: The Laryngoscope (Laryngoscope) Vol. 124 Issue 6 Pg. 1382-5 (Jun 2014) ISSN: 1531-4995 [Electronic] United States
• PMID: 24166585 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Chemical References

• Antigens, Bacterial
• Bacterial Proteins
• Mtb8.4 protein, Mycobacterium tuberculosis
• RHOF protein, human
• rho GTP-Binding Proteins

Topics

• AIDS-Related Opportunistic Infections (complications, diagnosis)
• Adult
• Antigens, Bacterial (metabolism)
• Bacterial Proteins (metabolism)
• Biopsy, Fine-Needle
• Cohort Studies
• Confidence Intervals
• Female
• HIV Infections (complications, diagnosis)
• Humans
• Lymphadenitis (diagnosis, microbiology)
• Male
• Mycobacterium tuberculosis (isolation & purification)
• Neck
• Nucleic Acid Amplification Techniques (methods)
• Prospective Studies
• Sensitivity and Specificity
• Tuberculosis, Lymph Node (complications, microbiology, pathology)
• Young Adult
• rho GTP-Binding Proteins (metabolism)