Alvarez-Uria Gerardo, Azcona Jose M, Midde Manoranjan, Naik Praveen K, Reddy Srinivasulu, Reddy Raghuprakash
Department of Infectious Diseases, Rural Development Trust Hospital, Kadiri Road, Anantapur District, Andhra Pradesh, Bathalapalli 515661, India.
Tuberc Res Treat. 2012;2012:932862. doi: 10.1155/2012/932862. Epub 2012 Aug 26.
HIV-related tuberculosis is difficult to diagnose and is associated with high morbidity and mortality. Recently, the World Health Organization has endorsed the GeneXpert MTB/RIF (Xpert) assay for the diagnosis of pulmonary tuberculosis in HIV-infected patients from developing countries, but information about the use of Xpert for the diagnosis of extrapulmonary tuberculosis is scarce. In this study, we compared the performance of light-emitting diode (LED) auramine fluorescent microscopy and the Xpert assay for the diagnosis of tuberculosis in HIV infected patients in a district hospital of India. Although at higher cost, Xpert outperformed LED fluorescent microscopy in all type of specimens, especially in cerebrospinal fluid where the number of positive results was increased 11 times. Pleural fluid, ascitic fluid, pus, and stool specimens also yielded positive results with the Xpert assay. When collecting two additional early-morning sputum samples, the increase of the number of positive results with the Xpert assay was lower than previously reported for HIV infected patients. Rifampicin resistance was observed in 2.2% of the cases. The results of this study show that the Xpert assay can dramatically improve the rapid diagnosis of tuberculous meningitis and other types of extrapulmonary tuberculosis of HIV infected patients.
与人类免疫缺陷病毒（HIV）相关的结核病难以诊断，且发病率和死亡率很高。最近，世界卫生组织认可了GeneXpert MTB/RIF（Xpert）检测法用于诊断来自发展中国家的HIV感染患者的肺结核，但关于使用Xpert诊断肺外结核病的信息却很少。在本研究中，我们比较了发光二极管（LED）金胺荧光显微镜检查和Xpert检测法在印度一家区级医院诊断HIV感染患者结核病中的性能。尽管成本较高，但Xpert在所有类型的标本中都优于LED荧光显微镜检查，尤其是在脑脊液中，阳性结果数量增加了11倍。胸腔积液、腹水、脓液和粪便标本通过Xpert检测法也得出了阳性结果。当额外采集两份清晨痰液样本时，Xpert检测法阳性结果数量的增加低于之前报道的HIV感染患者。在2.2%的病例中观察到利福平耐药。本研究结果表明，Xpert检测法可显著提高HIV感染患者结核性脑膜炎和其他类型肺外结核病的快速诊断率。
