在突尼斯使用GeneXpert MTB/RIF诊断淋巴结结核
Diagnosis of lymph node tuberculosis using the GeneXpert MTB/RIF in Tunisia.
作者信息
Ghariani Asma, Jaouadi Taha, Smaoui Selma, Mehiri Emna, Marouane Chama, Kammoun Sana, Essalah Leila, Driss Maha, Messadi Feriele, Slim-Saidi Leila
机构信息
National Reference Laboratory of Mycobacteria, Microbiology Laboratory, A. Mami Hospital of Pneumology, Ariana, Tunisia; Faculty of Pharmacy, Monastir, Tunisia.
National Reference Laboratory of Mycobacteria, Microbiology Laboratory, A. Mami Hospital of Pneumology, Ariana, Tunisia; Faculty of Pharmacy, Monastir, Tunisia.
出版信息
Int J Mycobacteriol. 2015 Dec;4(4):270-5. doi: 10.1016/j.ijmyco.2015.05.011. Epub 2015 Jun 27.
INTRODUCTION
GeneXpert MTB/RIF is a fully-automated diagnostic molecular test which simultaneously detects tuberculosis (TB) and rifampicin (RIF) drug resistance. The purpose of this study is to evaluate the performance of the GeneXpert MTB/RIF test for the detection of Mycobacterium tuberculosis complex (MTBC) in lymph node specimens and to show the place of Mycobacterium bovis as a major cause of TB lymphadenitis.
MATERIAL AND METHODS
This study was conducted simultaneously in the National Reference Laboratory for Mycobacteria of Ariana and the Central Laboratory of Sfax, from January to December 2013. In total, 174 lymph node specimens were processed simultaneously for Ziehl-Neelsen, auramine and immuno-histochemical staining. Conventional culture on both Lowenstein-Jensen and liquid medium (Bactec MGIT 960 BD system) and the new molecular-based GeneXpert MTB/RIF assay system were performed. Positive cultures were confirmed using molecular identification (Genotype MTBC Hain Lifescience).
RESULTS
Among the 174 samples tested, the GeneXpert detected the DNA of MTBC in 134 samples (77%). Standard bacteriological assays, including AFB microscopy and culture, were positive, respectively, in 41 (23.6%) and 79 (45.4%) specimens. M. bovis was isolated in 76% of positive cultures. GeneXpert sensitivity and specificity results were assessed according to smear and culture results, clinical and histological findings. The sensitivity and specificity of the Xpert assay were 87.5% (126/144) and 73.3%, respectively.
CONCLUSION
The implementation of the GeneXpert MTB/RIF assay may dramatically improve the rapid diagnosis of lymph node TB.
引言
GeneXpert MTB/RIF是一种全自动诊断分子检测方法，可同时检测结核病（TB）和利福平（RIF）耐药性。本研究的目的是评估GeneXpert MTB/RIF检测在淋巴结标本中检测结核分枝杆菌复合群（MTBC）的性能，并表明牛分枝杆菌作为结核性淋巴结炎主要病因的地位。
材料与方法
本研究于2013年1月至12月在阿丽亚娜国家分枝杆菌参考实验室和斯法克斯中央实验室同时进行。总共对174份淋巴结标本同时进行萋-尼氏染色、金胺染色和免疫组织化学染色。在罗氏培养基和液体培养基（Bactec MGIT 960 BD系统）上进行传统培养，并采用基于分子的新型GeneXpert MTB/RIF检测系统。使用分子鉴定（Genotype MTBC Hain Lifescience）确认阳性培养物。
结果
在检测的174个样本中，GeneXpert在134个样本（77%）中检测到MTBC的DNA。包括抗酸杆菌显微镜检查和培养在内的标准细菌学检测分别在41份（23.6%）和79份（45.4%）标本中呈阳性。在76%的阳性培养物中分离出牛分枝杆菌。根据涂片和培养结果、临床和组织学发现评估GeneXpert的敏感性和特异性结果。Xpert检测的敏感性和特异性分别为87.5%（126/144）和73.3%。
结论
实施GeneXpert MTB/RIF检测可能会显著改善淋巴结结核的快速诊断。
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