Ruth McNerney1, Alimuddin Zumla. 1. aDepartment of Clinical Sciences, London School of Hygiene and Tropical Medicine bCentre for Clinical Microbiology, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre at UCL Hospitals, London, UK.
Abstract
PURPOSE OF REVIEW: Control of tuberculosis necessitates prompt diagnosis and access to effective treatment. We discuss the impact of a new nucleic acid amplification test to assist diagnosis and detect rifampicin resistance. Following encouraging clinical performance studies, an automated PCR-based test, the Xpert MTB/RIF (Cepheid, Sunnyvale, CA), has been implemented on a global scale. Clinical trials to assess the impact of the new technology in primary healthcare clinics have been undertaken in tuberculosis (TB) endemic countries. RECENT FINDINGS: Clinical trials at the point of care in TB endemic countries demonstrated that increased numbers of TB patients are identified using the Xpert MTB/RIF assay as the frontline diagnostic test in place of sputum smear microscopy. Decreased times from sample collection to initiation of treatment were also reported when using the molecular test. However, overall case notification rates did not improve, and no significant impact on patient outcome (morbidity or mortality) was reported. SUMMARY: Sensitive molecular tests to assist diagnosis of tuberculosis may provide a faster diagnostic result when used in clinics and laboratories, but the limited impact on patient outcomes suggests additional interventions are needed to enhance TB control.
PURPOSE OF REVIEW: Control of tuberculosis necessitates prompt diagnosis and access to effective treatment. We discuss the impact of a new nucleic acid amplification test to assist diagnosis and detect rifampicin resistance. Following encouraging clinical performance studies, an automated PCR-based test, the Xpert MTB/RIF (Cepheid, Sunnyvale, CA), has been implemented on a global scale. Clinical trials to assess the impact of the new technology in primary healthcare clinics have been undertaken in tuberculosis (TB) endemic countries. RECENT FINDINGS: Clinical trials at the point of care in TB endemic countries demonstrated that increased numbers of TB patients are identified using the Xpert MTB/RIF assay as the frontline diagnostic test in place of sputum smear microscopy. Decreased times from sample collection to initiation of treatment were also reported when using the molecular test. However, overall case notification rates did not improve, and no significant impact on patient outcome (morbidity or mortality) was reported. SUMMARY: Sensitive molecular tests to assist diagnosis of tuberculosis may provide a faster diagnostic result when used in clinics and laboratories, but the limited impact on patient outcomes suggests additional interventions are needed to enhance TB control.
Authors: Marco Schito; Giovanni Battista Migliori; Helen A Fletcher; Ruth McNerney; Rosella Centis; Lia D'Ambrosio; Matthew Bates; Gibson Kibiki; Nathan Kapata; Tumena Corrah; Jamshed Bomanji; Cris Vilaplana; Daniel Johnson; Peter Mwaba; Markus Maeurer; Alimuddin Zumla Journal: Clin Infect Dis Date: 2015-10-15 Impact factor: 9.079
Authors: Ali M Somily; Mazin A Barry; Hanan A Habib; Fawzia E Alotaibi; Fahad A Al-Zamil; Mohammed A Khan; Mohammed S Sarwar; Nawab D Bakhash; Abdulkarim A Alrabiaah; Zahid A Shakoor; Abiola C Senok Journal: Saudi Med J Date: 2016-12 Impact factor: 1.484
Authors: Courtney M Yuen; Daniela Puma; Ana Karina Millones; Jerome T Galea; Christine Tzelios; Roger I Calderon; Meredith B Brooks; Judith Jimenez; Carmen Contreras; Tim C Nichols; Tom Nicholson; Leonid Lecca; Mercedes C Becerra; Salmaan Keshavjee Journal: BMJ Open Date: 2021-07-07 Impact factor: 2.692
Authors: Ankur Gupta-Wright; Katherine L Fielding; Joep J van Oosterhout; Douglas K Wilson; Elizabeth L Corbett; Clare Flach; Krishna P Reddy; Rochelle P Walensky; Jurgens A Peters; Melanie Alufandika-Moyo; Stephen D Lawn Journal: BMC Infect Dis Date: 2016-09-22 Impact factor: 3.090