Abstract
BackgroundTuberculous pleurisy (TP) presents a diagnostic problem due to the limitations of traditional diagnostic methods. Different studies with the Xpert MTB/RIF assay have drawn variable conclusions about its values in TP diagnosis. We conducted a meta-analysis to assess whether the Xpert MTB/RIF assay is appropriate for the diagnosis of TP using pleural fluid samples.MethodsA systematic search of four literature databases in English and Chinese language was performed to identify studies involving the use of Xpert MTB/RIF in patients with TP confirmed by plural biopsy and/or mycobacterial culture. Pooled sensitivity, specificity and accordance proportion were calculated, and the forest plots were generated to assess the accuracy of Xpert MTB/RIF for TP diagnosis.ResultsWe identified 23 studies meeting our inclusion criteria. The pooled sensitivity and specificity of Xpert MTB/RIF were 30% (95% CI: 21–42%, I2 = 87.93%) and 99% (95% CI: 97–100%, I2 = 96.20%), respectively, and the area under the SROC curve (AUC) of Xpert MTB/RIF was 0.86 (95% CI: 0.83–0.89). Compared with drug susceptibility testing (DST), the pooled accordance rate of Xpert MTB/RIF in detecting rifampicin-susceptible cases and rifampicin-resistant cases was 99% (95% CI: 95–104%, I2 = 8.7%) and 94% (95% CI: 86–102%), respectively.ConclusionsOur analysis suggests that the Xpert MTB/RIF assay is of limited value as a screening test for TP but has a high potential for confirming TP diagnosis and differentiating TP from non-TB diseases using pleural fluid samples.
Highlights
Tuberculous pleurisy (TP) presents a diagnostic problem due to the limitations of traditional diagnostic methods
Search was implemented by using combinations of the following items: “pleural tuberculosis”, “tuberculous pleuritis”, “tuberculous pleural effusion”, “TPE”, “Xpert MTB/RIF”, “GeneXpert”, “Xpert”, and “TB/RIF”
All these 23 studies demonstrated the performance of Xpert MTB/RIF in detecting TB or rifampicin resistance in TP patients confirmed following the gold standard involving a combination of mycobacterial culture and histopathological examination of pleural samples
Summary
Tuberculous pleurisy (TP) presents a diagnostic problem due to the limitations of traditional diagnostic methods. While pulmonary TB is the most common presentation, extra-pulmonary TB is an important clinical problem. Diagnosis of TP depends largely on detection of Mycobacterium tuberculosis in pleural fluid or pleura by microbiological culture, or demonstration. Over the past several years, there has been a significant increase in using the Xpert MTB/RIF assay ( referred to as Xpert; Cepheid Inc., USA), which is an automated, cartridge-based nucleic acid amplification test for TB. This assay has the ability to simultaneously detect M. tuberculosis nucleic acid and resistance to rifampin (RIF) in less than 2 h. Due to its excellent performance, this assay has been recommended by WHO for diagnosing TB and detecting rifampicin resistance in pulmonary and extra-pulmonary TB in adults and children as well as for initial screening of individuals suspected of having multiple drug resistant-TB (MDR-TB)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
