Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study

BMC Medicine

Bongani M Mayosi²  Keertan Dheda²  Mpiko Ntsekhe³  Ureshnie Govender¹  Grant Theron¹  Richard Meldau¹  Zita S Kerbelker³  Jonathan G Peter⁴  Shaheen Pandie³ 

[1] Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa;Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Groote Schuur Drive, Observatory, Cape Town 7925, South Africa;TB Vaccine Group, Jenner Institute, University of Oxford, Oxford, UK

关键词: Diagnosis;    Xpert MTB/RIF test;    Interferon γ;    Adenosine deaminase;    Tuberculous pericarditis;   

Others  :  797868
DOI  :  10.1186/1741-7015-12-101

 received in 2014-01-07, accepted in 2014-05-28,  发布年份 2014

【 摘 要 】

Background

Tuberculous pericarditis (TBP) is associated with high morbidity and mortality, and is an important treatable cause of heart failure in developing countries. Tuberculous aetiology of pericarditis is difficult to diagnose promptly. The utility of the new quantitative PCR test (Xpert MTB/RIF) for the diagnosis of TBP is unknown. This study sought to evaluate the diagnostic accuracy of the Xpert MTB/RIF test compared to pericardial adenosine deaminase (ADA) and unstimulated interferon-gamma (uIFNγ) in suspected TBP.

Methods

From October 2009 through September 2012, 151 consecutive patients with suspected TBP were enrolled at a single centre in Cape Town, South Africa. Mycobacterium tuberculosis culture and/or pericardial histology served as the reference standard for definite TBP. Receiver-operating-characteristic curve analysis was used for selection of ADA and uIFNγ cut-points.

Results

Of the participants, 49% (74/151) were classified as definite TBP, 33% (50/151) as probable TBP and 18% (27/151) as non TBP. A total of 105 (74%) participants were human immunodeficiency virus (HIV) positive. Xpert-MTB/RIF had a sensitivity and specificity (95% confidence interval (CI)) of 63.8% (52.4% to 75.1%) and 100% (85.6% to 100%), respectively. Concentration of pericardial fluid by centrifugation and using standard sample processing did not improve Xpert MTB/RIF accuracy. ADA (≥35 IU/L) and uIFNγ (≥44 pg/ml) both had a sensitivity of 95.7% (88.1% to 98.5%) and a negative likelihood ratio of 0.05 (0.02 to 0.10). However, the specificity and positive likelihood ratio of uIFNγ was higher than ADA (96.3% (81.7% to 99.3%) and 25.8 (3.6 to 183.4) versus 84% (65.4% to 93.6%) and 6.0 (3.7 to 9.8); P = 0.03) at an estimated background prevalence of TB of 30%. The sensitivity and negative predictive value of both uIFNγ and ADA were higher than Xpert-MT/RIF (P < 0.001).

Conclusions

uIFNγ offers superior accuracy for the diagnosis of microbiologically confirmed TBP compared to the ADA assay and the Xpert MTB/RIF test.

【 授权许可】

   
2014 Pandie et al.; licensee BioMed Central Ltd.

【 图 表 】

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