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Diagnostics of tuberculosis: An insight into Genexpert 27 4-15

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Tuberculosis, Genexpert Recommendations

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Diagnostics of tuberculosis: An insight into Genexpert 27 4-15

  1. 1. Diagnostics of Tuberculosis An insight into Gene Expert Dr. Muhammad Yahya Noori Assistant Professor Department of Pathology Focal Person for Provincial Tuberculosis Reference Lab Sindh DIMC DUHS
  2. 2. Tuberculosis Second only to HIV/AIDS One in three humans carries the Bacilli 2
  3. 3. The Cost 2013 1.5 Million Deaths 9 Million New Cases Drug Sensitive TB $100-500/case MDR TB $9000-48000/case 3
  4. 4. Pakistan Burden of Disease 4
  5. 5. Pakistan New Cases 5
  6. 6. Diagnosis of tuberculosis Latent Infection Active tuberculosis Smear examination Solid and liquid culture Identification Susceptibility testing methods TST IFN- techniques Molecular methods -Detection -Identification -Detection of resistance 6
  7. 7. 7
  8. 8. finddiadnostics.org
  9. 9. Example of Rif-Sensitive Profile – 5 probes are positive MTB/Rif Assay design Molecular Beacon Target Hybrid Each probe is labeled with a different fluorophore, permitting simultaneous detection of the presence of wild type. The MTB assay target is the 81 bp region (RRDR) of the rpoB gene. SPC 9
  10. 10. Xpert MTB/RIF Assay Satisfactory results were obtained in the studies that were performed in 2010: • Sensitivity in smear-positive culture-positive specimens: 99% • Sensitivity in smear-negative culture-positive specimens: 90% 10
  11. 11. WHO Evaluation on Xpert MTB/RIF Assay-2011 • Average detection time: – Solid culture: >30 days – Liquid culture: 17 days – Microscopy: 1 day – Xpert MTB/RIF: <1 day 11
  12. 12. WHO Evaluation on Xpert MTB/RIF Assay-2011 • Xpert MTB/RIF assay: – Analytical sensitivity: 5 genome copies/purified DNA or 131 cfu/ml sputum (10-100 cfu/ml sputum for culture) 12
  13. 13. Processing 13
  14. 14. Xpert MTB/RIF Assay Meta-Analysis Study • Average sensitivity for detection of rifampicin resistance: 94.1% • Average specificity for detection of rifampicin resistance: 97.0% • Average sensitivity in extra-pulmonary specimens: 80.4% • Average specificity in extra-pulmonary specimens : 86.1% 14
  15. 15. Current Practices 15
  16. 16. All smear Positive new treatment cases that remain +ve two months after treatment 16
  17. 17. All Hospitalized patients who have presumptive TB 17
  18. 18. Presumptive smear negative cases at high volume centers 18
  19. 19. Health care workers with TB symptoms 19
  20. 20. First line treatment failures 20
  21. 21. MDR-TB contacts 21
  22. 22. TB/HIV 22
  23. 23. History of ATT 23
  24. 24. Thank you 24

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