Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.

<h4>Purpose</h4>To determine the diagnostic accuracy of the Xpert MTB/RIF assay in patients with smear-negative pulmonary tuberculosis (TB) and to assess clinical and CT characteristics of Xpert-negative pulmonary TB.<h4>Material and methods</h4>We retrospectively reviewed th...

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Autores principales:	Han Na Lee, Jung Im Kim, Yee Hyung Kim
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/29ee98418c6e4934aa2d79a824948d46
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spelling	oai:doaj.org-article:29ee98418c6e4934aa2d79a824948d462021-12-02T20:05:43ZClinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.1932-620310.1371/journal.pone.0250616https://doaj.org/article/29ee98418c6e4934aa2d79a824948d462021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0250616https://doaj.org/toc/1932-6203<h4>Purpose</h4>To determine the diagnostic accuracy of the Xpert MTB/RIF assay in patients with smear-negative pulmonary tuberculosis (TB) and to assess clinical and CT characteristics of Xpert-negative pulmonary TB.<h4>Material and methods</h4>We retrospectively reviewed the records of 1,400 patients with suspected pulmonary TB for whom the sputum Xpert MTB/RIF assay was performed between September 1, 2014 and February 28, 2020. Clinical and CT characteristics of smear-negative pulmonary TB patients with negative Xpert MTB/RIF results were compared with positive results.<h4>Results</h4>Of 1,400 patients, 365 (26.1%) were diagnosed with pulmonary TB and 190 of 365 patients (52.1%) were negative for sputum acid-fast bacilli. The diagnosis of pulmonary TB was based on a positive culture, positive Xpert MTB/RIF or the clinical diagnoses of patients treated with an anti-TB medication. The sensitivity, specificity, positive predictive and negative predictive values of sputum Xpert MTB/RIF for smear-negative pulmonary TB were 41.1%, 100%, 100%, and 90.1%, respectively. Finally, 172 patients with smear-negative pulmonary TB who underwent chest CT within 2 weeks of diagnosis were included to compare Xpert-positive (n = 66) and Xpert- negative (n = 106) groups. Patients with sputum Xpert-negative TB showed lower positive rates for sputum culture (33.0% vs. 81.8%, p<0.001) and bronchoalveolar lavage culture (53.3% vs. 84.6%, p = 0.042) than in Xpert-positive TB. Time to start TB medication was longer in patients with Xpert-negative TB than in Xpert-positive TB (11.3±16.4 days vs. 5.0±8.7 days, p = 0.001). On chest CT, sputum Xpert-negative TB showed significantly lower frequency of consolidation (21.7% vs. 39.4%, p = 0.012), cavitation (23.6% vs. 37.9%, p = 0.045), more frequent peripheral location (50.9% vs. 21.2 p = 0.001) with lower area of involvement (4.3±4.3 vs. 7.6±6.4, p<0.001). Multivariate analysis revealed peripheral location (odds ratios, 2.565; 95% confidence interval: 1.157-5.687; p = 0.020) and higher total extent of the involved lobe (odds ratios, 0.928; 95% confidence interval: 0.865-0.995; p = 0.037) were significant factors associated with Xpert MTB/RIF-negative TB. Regardless of Xpert positivity, more than 80% of all cases were diagnosed of TB on chest CT by radiologists.<h4>Conclusion</h4>The detection rate of sputum Xpert MTB/RIF assay was relatively low for smear negative pulmonary TB. Chest CT image interpretation may play an important role in early diagnosis and treatment of Xpert MTB/RIF-negative pulmonary TB.Han Na LeeJung Im KimYee Hyung KimPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0250616 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Han Na Lee Jung Im Kim Yee Hyung Kim Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.
description	<h4>Purpose</h4>To determine the diagnostic accuracy of the Xpert MTB/RIF assay in patients with smear-negative pulmonary tuberculosis (TB) and to assess clinical and CT characteristics of Xpert-negative pulmonary TB.<h4>Material and methods</h4>We retrospectively reviewed the records of 1,400 patients with suspected pulmonary TB for whom the sputum Xpert MTB/RIF assay was performed between September 1, 2014 and February 28, 2020. Clinical and CT characteristics of smear-negative pulmonary TB patients with negative Xpert MTB/RIF results were compared with positive results.<h4>Results</h4>Of 1,400 patients, 365 (26.1%) were diagnosed with pulmonary TB and 190 of 365 patients (52.1%) were negative for sputum acid-fast bacilli. The diagnosis of pulmonary TB was based on a positive culture, positive Xpert MTB/RIF or the clinical diagnoses of patients treated with an anti-TB medication. The sensitivity, specificity, positive predictive and negative predictive values of sputum Xpert MTB/RIF for smear-negative pulmonary TB were 41.1%, 100%, 100%, and 90.1%, respectively. Finally, 172 patients with smear-negative pulmonary TB who underwent chest CT within 2 weeks of diagnosis were included to compare Xpert-positive (n = 66) and Xpert- negative (n = 106) groups. Patients with sputum Xpert-negative TB showed lower positive rates for sputum culture (33.0% vs. 81.8%, p<0.001) and bronchoalveolar lavage culture (53.3% vs. 84.6%, p = 0.042) than in Xpert-positive TB. Time to start TB medication was longer in patients with Xpert-negative TB than in Xpert-positive TB (11.3±16.4 days vs. 5.0±8.7 days, p = 0.001). On chest CT, sputum Xpert-negative TB showed significantly lower frequency of consolidation (21.7% vs. 39.4%, p = 0.012), cavitation (23.6% vs. 37.9%, p = 0.045), more frequent peripheral location (50.9% vs. 21.2 p = 0.001) with lower area of involvement (4.3±4.3 vs. 7.6±6.4, p<0.001). Multivariate analysis revealed peripheral location (odds ratios, 2.565; 95% confidence interval: 1.157-5.687; p = 0.020) and higher total extent of the involved lobe (odds ratios, 0.928; 95% confidence interval: 0.865-0.995; p = 0.037) were significant factors associated with Xpert MTB/RIF-negative TB. Regardless of Xpert positivity, more than 80% of all cases were diagnosed of TB on chest CT by radiologists.<h4>Conclusion</h4>The detection rate of sputum Xpert MTB/RIF assay was relatively low for smear negative pulmonary TB. Chest CT image interpretation may play an important role in early diagnosis and treatment of Xpert MTB/RIF-negative pulmonary TB.
format	article
author	Han Na Lee Jung Im Kim Yee Hyung Kim
author_facet	Han Na Lee Jung Im Kim Yee Hyung Kim
author_sort	Han Na Lee
title	Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.
title_short	Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.
title_full	Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.
title_fullStr	Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.
title_full_unstemmed	Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.
title_sort	clinical and ct characteristics of xpert mtb/rif-negative pulmonary tuberculosis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/29ee98418c6e4934aa2d79a824948d46
work_keys_str_mv	AT hannalee clinicalandctcharacteristicsofxpertmtbrifnegativepulmonarytuberculosis AT jungimkim clinicalandctcharacteristicsofxpertmtbrifnegativepulmonarytuberculosis AT yeehyungkim clinicalandctcharacteristicsofxpertmtbrifnegativepulmonarytuberculosis
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Clinical and CT characteristics of Xpert MTB/RIF-negative pulmonary tuberculosis.

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