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
ARTICLE HIGHLIGHTS
Research background

Tuberculosis (TB) is among the top ten causes of mortality worldwide. In 2019, an estimated 10.0 million were affected with TB globally, of which 1.2 million died. India topped the list of eight high burden TB countries, which contribute to almost 26% of the global TB cases. Osteoarticular tuberculosis (OATB) is a form of extrapulmonary TB that comprises 1.0%-4.3% of total tuberculosis cases and 10%-15% of all extrapulmonary TB cases. OATB remains a significant problem worldwide, leading to severe deformities and functional disability due to difficulty in diagnosis and delay in the initiation of specific treatment. Moreover, India is an endemic focus of TB, where most orthopedic surgeons continue to practice diagnosing OATB solely on clinical and radiological findings and initiating empirical anti-TB treatment.

Research motivation

There is a need for a molecular diagnostic test with a short turnaround time to diagnose OATB rapidly. In 2010, the World Health Organization recommended using Xpert MTB/RIF assay in pulmonary TB cases for concurrent diagnosis and rifampicin resistance of TB bacilli.

Research objectives

The objective is to estimate the efficacy of gene Xpert assay for the precise diagnosis of OATB.

Research methods

This retrospective study was conducted by analyzing the data of the gene Xpert assay over a 3-year period. The diagnostic efficiency of gene Xpert was evaluated against the composite reference standard.

Research results

A total of 37 cases fell into positive, probable, and possible categories of OATB out of 112 patients included in the study by composite reference standard; gene Xpert result was positive in 35 out of the 37 different composite reference standard categorized cases. Follow-up of the gene Xpert positive patients after getting anti-tubercular treatment revealed improved conditions.

Research conclusions

Conventional diagnostic methods such as smear are done everywhere for mycobacterium TB diagnosis, which is negative in most orthopedic cases.

Research perspectives

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.