Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2022; 13(3): 289-296
Published online Mar 18, 2022. doi: 10.5312/wjo.v13.i3.289
Diagnostic role of Xpert-MTB RIF assay in osteoarticular tuberculosis: A retrospective study
Monalisa Mohanty, Baijayantimala Mishra, Mantu Jain, Lubaib Karaniveed Puthiyapura
Monalisa Mohanty, Baijayantimala Mishra, Department of Microbiology, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India
Mantu Jain, Lubaib Karaniveed Puthiyapura, Department of Orthopaedics, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India
Author contributions: Mohanty M and Mishra B conceived the idea; Jain M created the proposal and Mishra B received the clearance; Mohanty M and Puthiyapura LK collected the data; Jain M and Mohanty M wrote the paper; Mishra B and Puthiyapura LK revised the manuscript for important intellectual content; All authors have read and agreed to the content of the manuscript.
Institutional review board statement: Clearance was obtained by Institution Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mantu Jain, MD, Doctor, Surgeon, Department of Orthopaedics, AIIMS Bhubaneswar, Patrapada, Bhubaneswar 751019, Odisha, India. montu_jn@yahoo.com
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: December 10, 2021
Revised: December 11, 2022
Accepted: January 27, 2022
Article in press: January 27, 2022
Published online: March 18, 2022
Processing time: 157 Days and 0 Hours
Abstract
BACKGROUND

Osteoarticular tuberculosis (OATB) is a severe form of extrapulmonary tuberculosis (TB), which causes notable morbidity and warrants a high index of suspicion for prompt management. The diagnosis of OATB poses a challenge, because of the difficulty of collecting the samples and, secondarily, the paucibacillary nature of lesion, which gives poor sensitivity and reproducibility, with long turnaround time of routine/conventional laboratory tests and the requirement for invasive procedures and expertise. The Xpert MTB/RIF assay has been approved by the World Health Organization as a rapid diagnostic tool for diagnosing pulmonary and extrapulmonary TB.

AIM

To emphasize the diagnostic efficiency of gene Xpert for OATB in suspected patients in a tertiary care hospital of Eastern India.

METHODS

This retrospective study was conducted in the Department of Microbiology and Orthopaedics by analyzing the data of the gene Xpert assay over a 3-year duration from January 2018 to February 2021. Demographic and clinical data were recorded. The diagnostic efficiency of gene Xpert was evaluated against the composite reference standard (CRS).

RESULTS

A total of 37 cases fell into positive, probable, and possible categories of osteoarticular TB out of 112 patients included in the study by CRS; gene Xpert result was positive in 35 out of the 37 different CRS categorized cases. Of the 112 cases, culture was put in 40 cases, and, of these cultures, 5 cases showed the growth of MTB. Of these, 4 cases were included in the 35 cases diagnosed by gene Xpert. Smear microscopy was positive in 6 out of 37 CRS categorized cases. When compared with CRS, the sensitivity of gene Xpert assay, culture, and smear was found to be 94.6%, 13.5%, and 16.2%, respectively, while specificity in all the three types of tests was 100%. When kappa statistics were applied, the percentage of agreement gene Xpert, culture, and microscopy with CRS was found to be 95%, 20%, and 22.6%, respectively. Follow-up of the gene Xpert positive patients after getting anti-tubercular treatment revealed improved conditions.

CONCLUSION

Gene Xpert could detect 31 extra cases with a low and very low mycobacterial load that were missed by the routine culture methods. Hence, more samples should be processed for molecular diagnostic methods like gene Xpert along with other conventional methods for the validation of the molecular test prospectively for the timely diagnosis of osteoarticular TB.

Keywords: Tuberculosis; Extrapulmonary; Osteoarticular; Gene Xpert assay; Composite reference standard

Core Tip: Osteoarticular tuberculosis (OATB) is a severe form of extrapulmonary tuberculosis (TB) that needs prompt management. However, there is difficulty in collecting samples and, secondarily, the paucibacillary nature of the lesion gives poor sensitivity and reproducibility, often with long turnaround time of the routine conventional laboratory tests. Xpert MTB RIF assay has been approved by the World Health Organization for rapid diagnosis of pulmonary/extrapulmonary TB. This study aims to find the diagnostic efficiency of gene Xpert for OATB in suspected patients. We found sensitivity of gene Xpert assay, culture, and smear when compared with CRS to be 94.6%, 13.5%, and 16.2%, respectively, while specificity in all the three types of tests was 100%. The kappa percentage of agreement for gene Xpert, culture, and microscopy were found to be 95%, 20%, and 22.6%, respectively. Follow-up of the gene Xpert positive patients after getting anti-tubercular treatment revealed improvement of their conditions. We conclude that gene Xpert has higher sensitivity than other conventional tests for the timely diagnosis of OATB.