Sensitivity and Specificity Assessment of Histopathology and GeneXpert in Diagnosing Extrapulmonary Tuberculosis at Gulab Devi Hospital, Lahore, Pakistan: A Retrospective Study: Sensitivity and Specificity in Diagnosing Extrapulmonary Tuberculosis

Rameesha Mohsin; Maratab Ali; Mahwish Siddique; Mohsin Zaheer; Atiqa Ambreen; Hamail Khanum

doi:10.54393/pjhs.v5i10.1818

Authors

Rameesha Mohsin Gulab Devi Hospital, Lahore, Pakistan
Maratab Ali Gulab Devi Hospital, Lahore, Pakistan
Mahwish Siddique Gulab Devi Hospital, Lahore, Pakistan
Mohsin Zaheer Lahore General Hospital, Pakistan
Atiqa Ambreen Gulab Devi Hospital, Lahore, Pakistan
Hamail Khanum Gulab Devi Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i10.1818

Keywords:

Extrapulmonary Tuberculosis, Spinal Tuberculosis, Gene Xpert, Sensitivity, Specificity

Abstract

Extrapulmonary Tuberculosis (EPTB), including Spinal Tuberculosis (STB), poses diagnostic challenges due to diverse clinical presentations and limitations of conventional diagnostic methods. Objective: To assess the sensitivity and specificity of Gene Xpert and histopathology in diagnosing EPTB at Gulab Devi Chest Hospital, Lahore, Pakistan. Methods: Data from patients diagnosed with EPTB between May 15th and October 15th, 2024, were analyzed. Gene Xpert and histopathology results were compared with Culture as the gold standard. Results: The study included 299 individuals, 61.2% of whom were females and 38.8% of whom were males. Gene Xpert demonstrated a sensitivity of 90.48% and specificity of 59.75%, while histopathology exhibited a sensitivity of 88.89% and specificity of 60.17%. Conclusion: Gene Xpert and histopathology were valuable tools for diagnosing EPTB, complementing traditional methods.

References

Sharma SK, Mohan A, Kohli M. Extrapulmonary tuberculosis. Expert Review of Respiratory Medicine. 2021 Jul; 15(7): 931-48. doi: 10.1080/17476348.2021.1927718.

World Health Organization. Global tuberculosis report 2021: supplementary material. World Health Organization; 2022.

Petersen E, Al-Abri S, Chakaya J, Goletti D, Parolina L, Wejse C et al. World TB Day 2022: Revamping and reshaping global TB control programs by advancing lessons learnt from the COVID-19 pandemic. International Journal of Infectious Diseases. 2022 Nov; 124: S1-3. doi: 10.1016/j.ijid.2022.02.057.

Gopalaswamy R, Dusthackeer VA, Kannayan S, Subbian S. Extrapulmonary tuberculosis-an update on the diagnosis, treatment and drug resistance. Journal of Respiration. 2021 May; 1(2): 141-64. doi: 10.3390/jor1020015.

Engel N, Ochodo EA, Karanja PW, Schmidt BM, Janssen R, Steingart KR et al. Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views. Cochrane Database of Systematic Reviews. 2022 Apr; 4(4): CD014877. doi: 10.1002/14651858.CD014877.pub2.

Xie L, Zhu XY, Xu L, Xu XX, Ruan ZF, Huang MX et al. Accurate and affordable detection of rifampicin and isoniazid resistance in Tuberculosis sputum specimens by multiplex PCR-multiple probes melting analysis. Infection. 2024 Jun: 1-28. doi: 10.1007/s15010-024-02295-w.

Mechal Y, Benaissa E, El Mrimar N, Benlahlou Y, Bssaibis F, Zegmout A et al. Evaluation of GeneXpert MTB/RIF system performances in the diagnosis of extrapulmonary tuberculosis. BioMed Central Infectious Diseases. 2019 Dec; 19: 1-8. doi: 10.1186/s12879-019-4687-7.

Bleed D, Dye C, Raviglione MC. Dynamics and control of the global tuberculosis epidemic. Current Opinion in Pulmonary Medicine. 2000 May; 6(3): 174-9. doi: 10.1097/00063198-200005000-00002.

Batool R, Imran M, Kandhro AH, Salahuddin N, Uddin MK. Resistance patterns among multidrug-resistant tuberculosis patients: a multi-center study from Pakistan. International Journal of Endorsing Health Science Research. 2017 Dec; 5(4): 07-11. doi: 10.29052/IJEHSR.v5.i4.2017.07-11.

Lawn SD and Nicol MP. Xpert® MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance. Future Microbiology. 2011 Sep; 6(9): 1067-82. doi: 10.2217/fmb.11.84.

Uddin MK, Ather MF, Kabir S, Rahman A, Choudhury S, Nasrin R et al. Diagnostic Performance of Different Laboratory Methods for the Detection of Extrapulmonary Tuberculosis. Microorganisms. 2023 Apr; 11(4): 1066. doi: 10.3390/microorganisms11041066.

Pongpeeradech N, Kasetchareo Y, Chuchottaworn C, Lawpoolsri S, Silachamroon U, Kaewkungwal J. Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand. PLOS One. 2022 Jul; 17(7): e0271130. doi: 10.1371/journal.pone.0271130.

Zaporojan N, Negrean RA, Hodișan R, Zaporojan C, Csep A, Zaha DC. Evolution of laboratory diagnosis of tuberculosis. Clinics and Practice. 2024 Feb; 14(2): 388-416. doi: 10.3390/clinpract14020030.

Mousavi-Sagharchi SM, Afrazeh E, Seyyedian-Nikjeh SF, Meskini M, Doroud D, Siadat SD. New insight in molecular detection of Mycobacterium tuberculosis. AMB Express. 2024 Dec; 14(1): 1-20. doi: 10.1186/s13568-024-01730-3.

Jakhar S, Bitzer AA, Stromberg LR, Mukundan H. Pediatric tuberculosis: the impact of "omics" on diagnostics development. International Journal of Molecular Sciences. 2020 Sep; 21(19): 6979. doi: 10.3390/ijms21196979.

Acharya B, Acharya A, Gautam S, Ghimire SP, Mishra G, Parajuli N et al. Advances in diagnosis of Tuberculosis: an update into molecular diagnosis of Mycobacterium tuberculosis. Molecular Biology Reports. 2020 May; 47: 4065-75. doi: 10.1007/s11033-020-05413-7.

Dheda K, Gumbo T, Maartens G, Dooley KE, McNerney R, Murray M et al. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. The Lancet Respiratory Medicine. 2017 Apr; 5(4): 291-360. doi: 10.1016/S2213-2600(17)30079-6.

Chapman HJ and Lauzardo M. Advances in diagnosis and treatment of latent tuberculosis infection. The Journal of the American Board of Family Medicine. 2014 Sep; 27(5): 704-12. doi: 10.3122/jabfm.2014.05.140062.

Ahmad S, Fares E, Araj GF, Chugh T, Mustafa A. Prevalence of S315T mutation within the katG gene in isoniazid-resistant clinical Mycobacterium tuberculosis isolates from Dubai and Beirut. The International Journal of Tuberculosis and Lung Disease. 2002 Oct; 6(10): 920-6.

Al-Mutairi NM, Ahmad S, Mokaddas E. Performance comparison of four methods for detecting multidrug-resistant Mycobacterium tuberculosis strains. The International Journal of Tuberculosis and Lung Disease. 2011 Jan; 15(1): 110-5.

Yu Y, Kong Y, Ye J, Wang A. Performance of conventional histopathology and GeneXpert MTB/RIF in the diagnosis of spinal tuberculosis from bone specimens: a prospective clinical study. Clinical Biochemistry. 2020 Nov; 85: 33-7. doi: 10.1016/j.clinbiochem.2020.08.010.

Kohli M, Schiller I, Dendukuri N, Dheda K, Denkinger CM, Schumacher SG et al. Xpert® MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. Cochrane Database of Systematic Reviews. 2018(8). doi: 10.1002/14651858.CD012768.pub2.

Karthek V, Bhilare P, Hadgaonkar S, Kothari A, Shyam A, Sancheti P et al. Gene Xpert/MTB RIF assay for spinal tuberculosis-sensitivity, specificity and clinical utility. Journal of Clinical Orthopaedics and Trauma. 2021 May; 16: 233-8. doi: 10.1016/j.jcot.2021.02.006.

Tahseen S, Ambreen A, Ishtiaq S, Khanzada FM, Safdar N, Sviland L et al. The value of histological examination in the diagnosis of tuberculous lymphadenitis in the era of rapid molecular diagnosis. Scientific Reports. 2022 May; 12(1): 8949. doi: 10.1038/s41598-022-12660-0.