Volume 7 | Issue 1 | January-June 2022 | Page: 01-06 | Abhijith Shetty, Saijyot Raut, Manikant Anand, Vishal Kundnani, Praveen Goparaju, Mukul Jain

DOI: 10.13107/ijs.2020.v07i01.031

Authors: Abhijith Shetty [1], Saijyot Raut [1], Manikant Anand [1], Vishal Kundnani [1], Praveen Goparaju [1], Mukul Jain [1]

[1] Department of Orthopaedics, Bombay Hospital and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhijith Shetty,
Spine Surgeon, Department of Orthopaedics, Bombay Hospital and Research
Centre, Mumbai, Maharashtra, India.
E-mail: abhijithshettyabhi03@gmail.com

Abstract

Background: Spinal Tuberculosis (TB) is one of the significant health dangers that affect the general wellbeing of an individual. It is one of the most common form of extra pulmonary tuberculosis that affects the general population. Diagnosis of tuberculosis is done using an array of techniques. The present study has compared the efficacy of these tests used for detecting the spinal TB in biopsy samples.
Material and Methods: The study was conducted on patients who suffered from spondylodiscitis and with biopsy proven spinal TB by one of the following tests and were treated in the study center. The study included a total of 150 patients with spinal TB who visited the department for further treatment. The biopsy samples of these patients were then processed for Line probe assay (LPA), Gene Xpert, liquid culture (bactec MGIT) followed by gram staining and fungal staining, and histopathological examination.
Result: In this study total of 150 patients were included who had ages ranging from 16-77 years with 93male and 57 female patients. When the study results were compared Gene Experts showed a 100% sensitivity and 80% of specificity. When we compared the histopathology results with gene expert, we get a sensitivity of 16.7% and specificity of 50%.
Gram stain with the sensitive gene expert, the sensitivity is 45.5% and specificity is 25%. Similar analysis was done with sensitive gene and now with the resistant gene to identify their sensitivity was 0% and the specificity was at 42.9%. Gram stain when correlated with gene, the sensitivity came out to be 9.1% and specificity at 25%. Fungal stain with resistant gene, when correlated, sensitivity comes to 9.1% and specificity is at 0%.
Conclusion: This study showed that for detection of tuberculosis rather than relying on only single technique it should be done with a combination of techniques.
Keywords: Gene Xpert, LPA, Histopathological examination, Tuberculosis, Gram staining

References

1. Dhuria M, Sharma N, Ingle G. Impact of tuberculosis on the quality of life. Indian J Community Med Off Publ Indian AssocPrevSoc Med. 2008 Jan;33(1):58–9.
2. Sulis G, Roggi A, Matteelli A, Raviglione MC. Tuberculosis: epidemiology and control. Mediterr J Hematol Infect Dis. 2014;6(1):e2014070.
3. Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34(5):440–54.
4. Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006 Sep;6(9):570–81.
5. Palomino JC, Martin A, Von Groll A, Portaels F. Rapid culture-based methods for drug-resistance detection in Mycobacterium tuberculosis. J Microbiol Methods. 2008 Oct;75(2):161–6.
6. Desikan P, Panwalkar N, Mirza SB, Chaturvedi A, Ansari K, Varathe R, et al. Line probe assay for detection of Mycobacterium tuberculosis complex: An experience from Central India. Indian J Med Res. 2017 Jan;145(1):70–3.
7. Reither K, Manyama C, Clowes P, Rachow A, Mapamba D, Steiner A, et al. Xpert MTB/RIF assay for diagnosis of pulmonary tuberculosis in children: a prospective, multi-centre evaluation. J Infect. 2015 Apr;70(4):392–9.
8. Opota O, Mazza-Stalder J, Greub G, Jaton K. The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection. ClinMicrobiol Infect Off PublEurSocClinMicrobiol Infect Dis. 2019 Nov;25(11):1370–6.
9. Patel J, Upadhyay M, Kundnani V, Merchant Z, Jain S, Kire N. Diagnostic Efficacy, Sensitivity, and Specificity of Xpert MTB/RIF Assay for Spinal Tuberculosis and Rifampicin Resistance. Spine. 2020 Feb 1;45(3):163–9.
10. Lawn SD, Nicol MP. Xpert® MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance. Future Microbiol. 2011 Sep;6(9):1067–82.
11. Buyankhishig B, Oyuntuya T, Tserelmaa B, Sarantuya J, Lucero MG, Mitarai S. Rapid molecular testing for multi-resistant tuberculosis in Mongolia: A diagnostic accuracy study. Int J Mycobacteriology. 2012 Mar;1(1):40–4.
12. Caulfield AJ, Wengenack NL. Diagnosis of active tuberculosis disease: From microscopy to molecular techniques. J ClinTubercMycobact Dis. 2016 Aug 1;4:33–43.
13. Singh BK, Sharma SK, Sharma R, Sreenivas V, Myneedu VP, Kohli M, et al. Diagnostic utility of a line probe assay for multidrug resistant-TB in smear-negative pulmonary tuberculosis. PLOS ONE. 2017 Aug 22;12(8):e0182988.
14. Crudu V, Stratan E, Romancenco E, Allerheiligen V, Hillemann A, Moraru N. First evaluation of an improved assay for molecular genetic detection of tuberculosis as well as rifampin and isoniazid resistances.J ClinMicrobiol. 2012 Apr;50(4):1264–9.
15. Zong Z, Huo F, Shi J, Jing W, Ma Y, Liang Q, et al. Relapse Versus Reinfection of Recurrent Tuberculosis Patients in a National Tuberculosis Specialized Hospital in Beijing, China. Front Microbiol. 2018;9:1858.
16. Rufai SB, Kumar P, Singh A, Prajapati S, Balooni V, Singh S. Comparison of Xpert MTB/RIF with line probe assay for detection of rifampin-monoresistant Mycobacterium tuberculosis. J ClinMicrobiol. 2014 Jun;52(6):1846–52.
17. Hillemann D, Rusch-Gerdes S, Boehme C, Richter E. Rapid Molecular Detection of Extrapulmonary Tuberculosis by the Automated GeneXpert MTB/RIF System. J ClinMicrobiol. 2011 Apr 1;49(4):1202–5.

(Abstract Text HTML)         (Download PDF)