<xhtml:span xmlns:xhtml="http://www.w3.org/1999/xhtml" xml:lang="en">Comparison of diagnostic accuracy of Xpert MTB/RIF and Geno type MTBDRplus line probe assayfor&#160;diagnosis of tuberculous pleural effusion </xhtml:span>

  1. Ayesha Sharif
  2. Maham Vaqar
  3. Kauser Jabeen
  4. Muhammad Irfan

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Abstract

Background : Tuberculous pleural effusion (TPE) occurs in up to 25% of TB patients. Owing to the pauci-bacillary nature of the pleural fluid, the diagnosis of TPE is a challenge. Newer diagnostic tools are required for the rapid diagnosis of TPE. Objectives : To compare the sensitivity and specificity of Xpert MTB/RIF and Geno type MTBDRplus line probe assay (MTBDRplus) for diagnosing TPE.  Methods : A prospective cross-sectional study was performed at Aga Khan University Hospital, Karachi, Pakistan from August 2014 to January 2016. Patients with suspected TPE were recruited on the basis of history, exudative lymphocytic nature of effusion and raised adenosine daminase level. Pleural fluid samples were tested for AFB smear, culture, Xpert MTB/RIFand MTBDR plus . Results :  We enrolled 99 patients with mean age of 50.4±20.3 years. AFB culture was positive in 14 (14.14%) cases. Considering AFB culture as Gold standard, the sensitivity of Xpert MTB/RIF was found to be 57.14% (95% CI: 28.86 – 82.34%) and specificity was 97.65% (95% CI: 91.76 - 99.71%) and the sensitivity of MTBDR plus  was  35.71% (95% CI: 12.76 – 64.86%) and specificity was 98.82% (95% CI: 93.62 - 99.90%).The sensitivity of Xpert MTB/RIF in TPE was higher than MTBDRplus (p 0.013), while specificity was similar. Conclusion :  Xpert MTB/RIF is more sensitive for detecting TPE than MTBDRplus and AFB smear microscopy. A multicenter, large-sample study is needed to evaluate this method for early TPE diagnosis.

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  2. Access Microbiology

    Comments to Author

    I recommend the authors to include headings such as introduction, results, discussion and methods in their manuscript. The methods used and the assays performed is not detailed; please elaborate this section. I recommend rewriting to improve the organisation of the manuscript and highlight key findings. Very limited discussion of results and cross comparison with different studies. I recommend he authors to elaborate the introduction and discussion , for instance, breaking down into various sections to provide the reader with ease of understanding the context of the work and relevance. I recommend the authors to check the grammar and wordings throughout the manuscript. Example: Line 82: To rapidly diagnose TPE..

    Please rate the manuscript for methodological rigour

    Poor

    Please rate the quality of the presentation and structure of the manuscript

    Poor

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    No: I could not see any details of the ethical statement used for the patient study. I recommend adding ethical statement to the manuscript.

  3. Version published to 10.1099/acmi.0.000527.v1 on Access Microbiology