Costantini Luisa, Marando Marco, Gianella Pietro
Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Department of Pneumology, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Eur J Case Rep Intern Med. 2020 Jul 6;7(10):001737. doi: 10.12890/2020_001737. eCollection 2020.
Tuberculosis (TB) is a cause of ill health and death worldwide. Since 2010, the diagnostic process has strongly relied on GeneXpert assays on biological specimens. Xpert MTB/RIF is an automated nucleic acid amplification test (NAAT) for and rifampicin resistance, endorsed by the World Health Organization and the US Food and Drug Administration. Xpert is used in many countries as the initial diagnostic test for tuberculosis. Nevertheless, the reliability of GeneXpert positive tests in patients with a history of TB is largely unknown, due to possible false-positive results (i.e., GeneXpert-positive but culture-negative patients). We present a case report of a patient with a history of pulmonary TB, who was GeneXpert positive but culture negative on bronchoalveolar lavage 22 months after completion of appropriate antitubercular therapy.
GeneXpert assays have a pivotal role in the diagnosis of tuberculosis (TB), with overall good sensitivity and excellent specificity.Patients with a history of TB can be GeneXpert positive up to several years after the end of appropriate antitubercular treatment.Further studies are warranted to fully understand the role of GeneXpert assays in the diagnostic algorithms of patients with a history of TB.
结核病是全球范围内导致健康问题和死亡的原因。自2010年以来,诊断过程强烈依赖于对生物样本进行的GeneXpert检测。Xpert MTB/RIF是一种用于检测结核分枝杆菌和利福平耐药性的自动化核酸扩增试验(NAAT),得到了世界卫生组织和美国食品药品监督管理局的认可。Xpert在许多国家被用作结核病的初始诊断试验。然而,由于可能出现假阳性结果(即GeneXpert检测呈阳性但培养结果为阴性的患者),GeneXpert检测在有结核病病史的患者中阳性结果的可靠性在很大程度上尚不清楚。我们报告了一例有肺结核病史的患者,在完成适当的抗结核治疗22个月后,其支气管肺泡灌洗样本的GeneXpert检测呈阳性但培养结果为阴性。
GeneXpert检测在结核病诊断中起着关键作用,总体敏感性良好,特异性优异。有结核病病史的患者在适当的抗结核治疗结束后数年,其GeneXpert检测仍可能呈阳性。有必要进行进一步研究,以充分了解GeneXpert检测在有结核病病史患者的诊断算法中的作用。