Afellah Mohamed, Zoukal Sofia, Benmansour Najib, Arioua Abdelilah, Ouattassi Naouar, El Amine El Alami Mohamed Noureddine
Otolaryngology, Hassan II University Hospital, Fez, MAR.
Laboratory of Epidemiology, Faculty of Medicine and Pharmacy/University Hassan II, Casablanca, MAR.
Cureus. 2024 Jul 20;16(7):e64979. doi: 10.7759/cureus.64979. eCollection 2024 Jul.
Background and objective Lymph node tuberculosis (LNTB) is a common manifestation of extrapulmonary tuberculosis (EPTB). GeneXpert is a rapid diagnostic molecular test that simultaneously detects tuberculosis and rifampicin (RIF) resistance. In this study, we aimed to assess the epidemiology of LNTB and diagnostic performance parameters of the GeneXpert in routine ENT practice. Methods We conducted a cross-sectional prospective study from January to July 2019, in the Department of Otorhinolaryngology and Head Neck Surgery at the Hassan II University Hospital Center of Fez, Morocco. The samples were collected using lymph node biopsy and subjected to GeneXpert assay, culture, and histopathology. Diagnostic performance parameters of the GeneXpert were calculated and compared with culture. Results All patients with cervical adenopathy were included. Lymph node biopsies were performed for all patients. The performance of the GeneXpert was assessed according to culture findings. Among the 75 cases, the mean age was 21.6 ± 12.7 years with a female predominance (60%). GeneXpert was positive in 66.7% of specimens. The sensitivity and specificity of the GeneXpert assay were 78.6% and 40.4% respectively. GeneXpert accuracy was 54.6%. The positive predictive value (PPV) and negative predictive value (NPV) were found to be 44% (95% CI: 30.2-57.8) and 76% (95% CI: 59.3-92.7) respectively. Mycobacterium bovis was isolated in all samples, with no case of resistance to RIF found. Conclusions The performance of GeneXpert was found to be superior in terms of establishing the diagnosis of LNTB. It offers speedy and prompt results and clinicians should adopt it in routine clinical practice.
背景与目的 淋巴结结核（LNTB）是肺外结核（EPTB）的常见表现形式。GeneXpert是一种快速诊断分子检测方法，可同时检测结核和利福平（RIF）耐药性。在本研究中，我们旨在评估在常规耳鼻喉科实践中LNTB的流行病学情况以及GeneXpert的诊断性能参数。方法 我们于2019年1月至7月在摩洛哥非斯哈桑二世大学医院中心的耳鼻喉头颈外科进行了一项横断面前瞻性研究。通过淋巴结活检采集样本，并进行GeneXpert检测、培养和组织病理学检查。计算GeneXpert的诊断性能参数并与培养结果进行比较。结果 纳入了所有患有颈部淋巴结病的患者。对所有患者均进行了淋巴结活检。根据培养结果评估GeneXpert的性能。在75例病例中，平均年龄为21.6±12.7岁，女性占优势（60%）。GeneXpert在66.7%的标本中呈阳性。GeneXpert检测的敏感性和特异性分别为78.6%和40.4%。GeneXpert的准确性为54.6%。阳性预测值（PPV）和阴性预测值（NPV）分别为44%（95%CI：30.2 - 57.8）和76%（95%CI：59.3 - 92.7）。所有样本中均分离出牛分枝杆菌，未发现对RIF耐药的病例。结论 在确立LNTB诊断方面，发现GeneXpert的性能更优。它能提供快速及时的结果，临床医生应在常规临床实践中采用。
