The utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence setting

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dc.contributor.authorBarnard, Dewald A.
dc.contributor.authorIrusen, Elvis M.
dc.contributor.authorBruwer, Johannes W.
dc.contributor.authorPlekker, Dante
dc.contributor.authorWhitelaw, Andrew C.
dc.contributor.authorDeetlefs, Jacobus D.
dc.contributor.authorKoegelenberg, Coenraad F. N.
dc.date.accessioned2015-10-16T13:29:23Z
dc.date.available2015-10-16T13:29:23Z
dc.date.issued2015-09
dc.descriptionThe original publication is available at http://www.biomedcentral.com/content/pdf/s12890-015-0086-z.pdfen_ZA
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.
dc.description.abstractBackground: Xpert MTB/RIF has been shown to have a superior sensitivity to microscopy for acid fast bacilli (AFB) in sputum and has been recommended as a standard first line investigation for pulmonary tuberculosis (PTB). Bronchoscopy is a valuable tool in diagnosing PTB in sputum negative patients. There is limited data on the utility of Xpert MTB/RIF performed on bronchial lavage specimens. Our aim was to evaluate the diagnostic efficiency of Xpert MTB/RIF performed on bronchial washings in sputum scarce/negative patients with suspected PTB. Methods: All patients with a clinical and radiological suspicion of PTB who underwent bronchoscopy between January 2013 and April 2014 were included. The diagnostic efficiencies of Xpert MTB/RIF and microscopy for AFB were compared to culture for Mycobacterium tuberculosis. Results: Thirty nine of 112 patients were diagnosed with culture-positive PTB. Xpert MTB/RIF was positive in 36/39 with a sensitivity of 92.3 % (95 % CI 78–98 %) for PTB, which was superior to that of smear microscopy (41 %; 95 % CI 26.0–57.8 %, p = 0.005). The specificities of Xpert MTB/RIF and smear microscopy were 87.7 % (95 % CI 77.4–93.9 %) and 98.6 % (95 % CI 91.6 %–99.9 %) respectively. Xpert MTB/RIF had a positive predictive value of 80 % (95 % CI; 65–89.9 %) and negative predictive value of 95.5 % (95 % CI 86.6–98.8 %). 3/9 patients with Xpert MTB/RIF positive culture negative results were treated for PTB based on clinical and radiological findings. Conclusion: Xpert MTB/RIF has a higher sensitivity than smear microscopy and similar specificity for the immediate confirmation of PTB in specimens obtained by bronchial washing, and should be utilised in patients with a high suspicion of pulmonary tuberculosis.en_ZA
dc.description.versionPublishers' versionen_ZA
dc.format.extent5 pagesen_ZA
dc.identifier.citationBarnard, D. A. et al. 2015. The utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence setting. BMC Pulmonary Medicine, 15(103), doi:10.1186/s12890-015-0086-z.en_ZA
dc.identifier.otherdoi: 10.1186/s12890-015-0086-z
dc.identifier.urihttp://hdl.handle.net/10019.1/97574
dc.language.isoenen_ZA
dc.publisherBioMed Centralen_ZA
dc.rights.holderOwners retain copyright
dc.subjectTuberculosisen_ZA
dc.subjectXpert MTB/RIFen_ZA
dc.titleThe utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence settingen_ZA
dc.typeArticleen_ZA
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