Diagnosis of extrapulmonary tuberculosis using the MPT64 antigen detection test in a high-income low tuberculosis prevalence setting.

Autor: Hoel IM; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. Ida.Hoel@uib.no.; Department of Clinical Science, University of Bergen, Bergen, Norway. Ida.Hoel@uib.no.; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Ida.Hoel@uib.no., Sviland L; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; Department of Pathology, Haukeland University Hospital, Oslo, Norway., Syre H; Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway., Dyrhol-Riise AM; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Skarstein I; Department of Microbiology, Haukeland University Hospital, Bergen, Norway., Jebsen P; Department of Pathology, Oslo University Hospital, Oslo, Norway., Jørstad MD; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway., Wiker H; Department of Clinical Science, University of Bergen, Bergen, Norway., Mustafa T; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2020 Feb 12; Vol. 20 (1), pp. 130. Date of Electronic Publication: 2020 Feb 12.
DOI: 10.1186/s12879-020-4852-z
Abstrakt: Background: Extrapulmonary tuberculosis (EPTB) poses diagnostic challenges due to the paucibacillary nature of the disease. The immunochemistry-based MPT64 antigen detection test (MPT64 test) has shown promising results for diagnosing EPTB in previous studies performed in low-resource settings, with higher sensitivity than microscopy and culture. The aim of this study was to investigate the performance of the MPT64 test in a routine clinical setting in a high-income low TB prevalence country.
Methods: Extrapulmonary samples sent for TB diagnostics to microbiology and pathology laboratories at three regional tertiary care hospitals in Norway in a one-year period were included and subjected to the MPT64 test in parallel to the routine TB diagnostic tests.
Results: Samples from 288 patients were included and categorised as confirmed TB cases (n = 26), clinically diagnosed TB cases (n = 5), non-TB cases (n = 243) and uncategorised (n = 14), using a composite reference standard (CRS). In formalin-fixed biopsies, the sensitivity (95% CI) of the MPT64 test, microscopy, PCR-based tests pooled, and culture was 37% (16-62), 20% (4-48), 37% (16-62) and 50% (23-77), respectively, against the CRS. The MPT64 test showed a good positive predictive value (88%) and an excellent specificity (99, 95% CI 92-100) in formalin-fixed biopsies. In fine-needle aspirates, pus and fluid samples, the test performance was lower.
Conclusions: The MPT64 test was implementable in pathology laboratories as part of routine diagnostics, and although the sensitivity of the MPT64 test was not better than culture in this setting, the test supplements other rapid diagnostic methods, including microscopy and PCR-based tests, and can contribute to strengthen the diagnosis of EPTB in formalin-fixed biopsies in the absence of culture confirmation.
Databáze: MEDLINE
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