Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study

 

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dc.contributor.author Pandie, Shaheen
dc.contributor.author Peter, Jonathan G
dc.contributor.author Kerbelker, Zita S
dc.contributor.author Meldau, Richard
dc.contributor.author Theron, Grant
dc.contributor.author Govender, Ureshnie
dc.contributor.author Ntsekhe, Mpiko
dc.contributor.author Dheda, Keertan
dc.contributor.author Mayosi, Bongani M
dc.date.accessioned 2015-09-26T05:52:52Z
dc.date.available 2015-09-26T05:52:52Z
dc.date.issued 2014-06-18
dc.identifier.citation Pandie, S., Peter, J. G., Kerbelker, Z. S., Meldau, R., Theron, G., Govender, U., ... & Mayosi, B. M. (2014). Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study. BMC medicine, 12(1), 101.
dc.identifier.uri http://dx.doi.org/10.1186/1741-7015-12-101
dc.identifier.uri http://hdl.handle.net/11427/14103
dc.identifier.uri http://hdl.handle.net/11427/14103
dc.identifier.uri http://dx.doi.org/10.1186/1741-7015-12-101
dc.description.abstract Background: Tuberculous pericarditis (TBP) is associated with high morbidity and mortality, and is an important treatable cause of heart failure in developing countries. Tuberculous aetiology of pericarditis is difficult to diagnose promptly. The utility of the new quantitative PCR test (Xpert MTB/RIF) for the diagnosis of TBP is unknown. This study sought to evaluate the diagnostic accuracy of the Xpert MTB/RIF test compared to pericardial adenosine deaminase (ADA) and unstimulated interferon-gamma (uIFNγ) in suspected TBP. Methods: From October 2009 through September 2012, 151 consecutive patients with suspected TBP were enrolled at a single centre in Cape Town, South Africa. Mycobacterium tuberculosis culture and/or pericardial histology served as the reference standard for definite TBP. Receiver-operating-characteristic curve analysis was used for selection of ADA and uIFNγ cut-points. Results: Of the participants, 49% (74/151) were classified as definite TBP, 33% (50/151) as probable TBP and 18% (27/151) as non TBP. A total of 105 (74%) participants were human immunodeficiency virus (HIV) positive. Xpert-MTB/RIF had a sensitivity and specificity (95% confidence interval (CI)) of 63.8% (52.4% to 75.1%) and 100% (85.6% to 100%), respectively. Concentration of pericardial fluid by centrifugation and using standard sample processing did not improve Xpert MTB/RIF accuracy. ADA (≥35 IU/L) and uIFNγ (≥44 pg/ml) both had a sensitivity of 95.7% (88.1% to 98.5%) and a negative likelihood ratio of 0.05 (0.02 to 0.10). However, the specificity and positive likelihood ratio of uIFNγ was higher than ADA (96.3% (81.7% to 99.3%) and 25.8 (3.6 to 183.4) versus 84% (65.4% to 93.6%) and 6.0 (3.7 to 9.8); P = 0.03) at an estimated background prevalence of TB of 30%. The sensitivity and negative predictive value of both uIFNγ and ADA were higher than Xpert-MT/RIF (P < 0.001). Conclusions: uIFNγ offers superior accuracy for the diagnosis of microbiologically confirmed TBP compared to the ADA assay and the Xpert MTB/RIF test.
dc.title Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study
dc.type Journal Article
dc.type Journal Article en_ZA
dc.date.updated 2015-09-10T18:01:15Z
dc.language.rfc3066 en
dc.rights.holder Pandie et al.; licensee BioMed Central Ltd. 2014
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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