Diagnosing Pleural TB

Although the Xpert MTB/RIF (Xpert) assay has become a valuable diagnostic tool in tuberculosis (TB) and rifampicin resistance, it does not have high-quality outcomes for pleural fluid detection. This study compared Xpert to next-generation Xpert MTB/RIF Ultra (Xpert Ultra) for pleural TB diagnosis. Pleural fluids from patients with suspected TB from four hospitals underwent smear, culture, and Xpert. Xpert Ultra was used to analyzed defrosted pleural fluid. All recovered isolates underwent drug susceptibility testing. Of the 317 patients with suspected pleural TB, 208 received a pleural TB diagnosis based on the composite reference standard (clinical, laboratory, histopathological, and radiological exams, as well as at least one year of follow-up data). Diagnostic sensitivity was higher in Xpert Ultra (92/208, 44.23%) compared to culture (26.44%, 55/208, P < 0.001), Xpert (19.23%, 40/208, P < 0.001) and smear (1.44%,3/208, P < 0.001). Incorporating the Xpert Ultra outcomes increased the percentage of confirmed pleural TB cases from 56.25% to 64.9%. Smear and culture both had a 100% specificity rate, and Xpert and Xpert Ultra both ad a 98.67% specificity rate. Xpert Ultra had a 100% concordance rate with phenotype drug susceptibility testing for rifampicin resistance detection. Read more