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Cox, Sharon E, Parry, Christopher, Ariyoshi, Koya, Calapis, Rugaiya W, Roy, Lynsil, Marin, Flora P, Parris, Victoria, Lee, Nathaniel and Thi, Aye Myat (2020) 'An observational report of universal GeneXpert testing of inpatients with diagnosed or presumptive TB in the Philippines'. Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol 114, Issue 9, 682 -686.
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Abstract
Background
The Philippines is a high TB and multidrug-resistant TB burden country. Although the scale-up of GeneXpert testing is occurring, the benefits of universal Xpert-Mycobacterium tuberculosis/ rifampicin (MTB/RIF) testing in inpatients have not been documented.
Methods
Routine GeneXpert testing irrespective of priority criteria for testing was conducted within a prospective cohort of all adults with known or presumptive TB admitted to a tertiary infectious diseases hospital in Manila. Study-specific TB diagnosis was decided upon bacteriological results, chest x-ray assessment, if already on anti-TB treatment (ATT) at admission and a cough duration of ≥2 wk.
Results
Of submitted sputum samples, 87.1% (277/318) had valid acid-fast bacilli (AFB) microscopy and Xpert® MTB/RIF results. Xpert® MTB/RIF was positive in 97.7% (n = 87/89) of AFB-positive patients and 25.5% (n = 48/188) of AFB-negative patients. Bacteriological confirmation in smear negative cases not on ATT prior to admission was 25.2% (34/135). Rifampicin resistance was detected in 26/135 Xpert positive cases (19.3%), including nine who might not otherwise have been detected, representing a 53% increase in yield.
Conclusion
Universal GeneXpert testing in this setting enhanced the yield of bacterial confirmation, revealing a high incidence of rifampicin resistance and suggesting a need for further investigations in Xpert-negative/smear-positive patients who may not have mycobacterial TB.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1093/trstmh/traa044 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 11 Aug 2020 12:17 |
| Last Modified: | 09 Sep 2020 12:00 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/15291 |
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