Patil Naveen, Saba Hamida, Marco Asween, Samant Rohan, Mukasa Leonard
Arkansas Department of Health ; University of Arkansas for Medical Sciences.
University of Arkansas for Medical Sciences.
Australas Med J. 2014 May 31;7(5):203-7. doi: 10.4066/AMJ.2014.1905. eCollection 2014.
Mycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. Rapid and accurate diagnosis of pulmonary and extra-pulmonary tuberculosis (TB) is still a great challenge. The GeneXpert MTB/RIF assay is a novel integrated diagnostic system for the diagnosis of tuberculosis and rapid detection of Rifampin (RIF) resistance in clinical specimens. In 2012, the Arkansas Tuberculosis Control Program introduced GeneXpert MTB/RIF assay to replace the labour-intensive Mycobacterium Tuberculosis Direct (MTD) assay.
To rapidly diagnose TB within two hours and to simultaneously detect RIF resistance.
Describe the procedure used to introduce GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program.Characterise the current gap in rapid M. tuberculosis diagnosis in Arkansas.Assess factors that predict acid fast bacilli (AFB) smearnegative but culture-positive cases in Arkansas.Illustrate, with two case reports, the role of GeneXpert MTB/RIF assay in reduction of time to confirmation of M. tuberculosis diagnosis in the first year of implementation.
Between June 2012 and June 2013, all AFB sputum smearpositive cases and any others, on request by the physician, had GeneXpert MTB/RIF assay performed as well as traditional M. tuberculosis culture and susceptibilities using Mycobacteria Growth Indicator Tube (MGIT) 960 and Löwenstein-Jensen (LJ) slants. Surveillance data for January 2009-June 2013 was analysed to characterise sputum smear-negative but culture-positive cases.
Seventy-one TB cases were reported from June 2012- June 2013. GeneXpert MTB/RIF assay identified all culture-positive cases as well as three cases that were negative on culture. Also, this rapid assay identified all six smear-negative but M. tuberculosis culture-positive cases; two of these cases are described as case reports.
GeneXpert MTB/RIF assay has made rapid TB diagnosis possible, with tremendous potential in determining isolation of TB suspects on one hand, and quickly ruling out TB whenever suspected.
结核分枝杆菌仍然是感染性疾病致死的主要原因之一。快速准确地诊断肺结核和肺外结核（TB）仍是一项巨大挑战。GeneXpert MTB/RIF检测是一种新型综合诊断系统，用于诊断结核病并快速检测临床标本中的利福平（RIF）耐药性。2012年，阿肯色州结核病控制项目引入了GeneXpert MTB/RIF检测，以取代劳动强度大的结核分枝杆菌直接检测（MTD）。
在两小时内快速诊断结核病并同时检测RIF耐药性。
描述在阿肯色州结核病控制项目中引入GeneXpert MTB/RIF检测所使用的程序。描述阿肯色州目前在快速诊断结核分枝杆菌方面的差距。评估预测阿肯色州抗酸杆菌（AFB）涂片阴性但培养阳性病例的因素。通过两个病例报告说明GeneXpert MTB/RIF检测在实施的第一年减少结核分枝杆菌诊断确认时间方面的作用。
2012年6月至2013年6月期间，所有AFB痰涂片阳性病例以及医生要求检测的其他病例均进行了GeneXpert MTB/RIF检测，同时使用分枝杆菌生长指示管（MGIT）960和罗氏（LJ）斜面进行传统结核分枝杆菌培养及药敏试验。分析了2009年1月至2013年6月的监测数据，以描述痰涂片阴性但培养阳性的病例。
2012年6月至2013年6月报告了71例结核病病例。GeneXpert MTB/RIF检测识别出所有培养阳性病例以及3例培养阴性病例。此外，这种快速检测识别出所有6例涂片阴性但结核分枝杆菌培养阳性的病例；其中两例作为病例报告进行了描述。
GeneXpert MTB/RIF检测使快速结核病诊断成为可能，一方面在确定结核病疑似病例的隔离方面具有巨大潜力，另一方面在怀疑结核病时能迅速排除。
