DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184904

Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center

Sunil Kumar Komanapalli, Uma Prasad, Bhagyalakshmi Atla, Vasundhara Nammi, Divya Yendluri

Abstract


Background: The diagnosis of extra-pulmonary tuberculosis (EPTB) is challenging due to the pauci-bacillary nature of disease. Recently, WHO recommends GeneXpert/CBNAAT to be used as the initial diagnostic test in patients suspected extra-pulmonary tuberculosis (EPTB). The study was done to assess the role of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) in the diagnosis of EPTB. Aims and objectives was to study the role of FNAC, CBNAAT and Fluorescent LED in diagnosing extra-pulmonary tuberculosis (EPTB).

Methods: This is a descriptive observational study carried out over a period of 12 months (April 2017 to March 2018) at department of Pathology, Andhra Medical College. All presumptive cases of extrapulmonary tuberculosis and purulent aspirates from the various sites between the age group of <10yrs to 60 years of age were included in the study. FNA was done and material sent to CBNAAT and fluorescent LED (Light-emitting Diode) microscopy in all the cases and results tabulated.

Results: The total number of cases with presumptive extra pulmonary Tb were 289. Majority of the aspirates are from lymph nodal and cervical swellings 94.1% (272/289). CBNAAT has detected 6.5 % of cases (19/289) which were not detected by FNA and 9.3% of cases (27/289) LED negative cases. Resistant to rifampicin was identified in 2.1% (3/142 cases) of CBNAAT positive cases.

Conclusions: FNA still remains the cheapest test to diagnose TB. In cases with Granulomatous lymphadenitis and purulent aspirates CBNAAT has an important role in diagnosing EPTB. In addition it offered rapid detection of rifampicin-resistant M. tuberculosis strains which is an added advantage.


Keywords


CB-NAAT, EPTB, Fine needle aspiration cytology

Full Text:

PDF

References


Ramirez-Lapausa M, Menendez-Saldana A, Noguerado-Asensio A. Extrapulmonary tuberculosis: an overview. Rev Esp Sanid Penit. 2015;17:3-11.

Takhar RP. NAAT: A new ray of hope in the early diagnosis of EPTB. Emerg Med (Los Angel). 2016;6:328.

Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuber Res Dis (Seoul). 2015 Apr;78(2):47-55.

Bekedam HJ1, Boeree M, Kamenya A, Liomba G, Ngwira B, Subramanyam VR, Harries AD. Tuberculous lymphadenitis, a diagnostic problem in areas of high prevalence of HIV and tuberculosis. Trans R Soc Trop Med Hyg. 1997 May-Jun;91(3):294-7.

Annam V, Karigoudar MH, Yelikar BR. Improved microscopical detection of acid-fast bacilli by the modified bleach method in lymphnode aspirates. Indian J PatholMicrobiol. 2009;52:349-52.

Gholoobi A, Masoudi-Kazemabad A, Meshkat M, Meshkat Z. Comparison of culture and PCR methods for diagnosis of mycobacterium tuberculosis in different clinical specimens. Jundishapur J Microbiol. 2014;7(2):e8939.

Dewan R, Anuradha S, Khanna A, Garg S, Singla S, Ish P, Agarwal S. Role of cartridge-based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV. JIACM. 2015;16(2):114-7.

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;6(9):1067-82.

World Health Organization. Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children: Policy Update. Geneva: WHO, 2013.

Biadglegne F, Mulu A, Rodloff AC, Sack U, Diagnostic performance of the Xpert MTB/RIF assay for tuberculous lymphadenitis on fine needle aspirates from Ethiopia. Tuberculosis (Edinb). 2014 Sep;94(5):502-5.

Hillemann D, Rüsch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF system. J Clinical Microbiol. 2011;49:1202-05.

World Health Organization. Xpert MTB/RIF implementation manual: technical and operational ‘how-to’: practical considerations, 2014. Available at:http://www.who.int/tb/publications/xpert_implem_manual/en/.

Singh UB, Pandey P, Mehta G, Bhatnagar AK, Mohan A, Goyal V, et al. Genotypic, phenotypic and clinical validation of GeneXpert in extra-pulmonary and pulmonary tuberculosis in India. PLoS ONE.2016;11(2):1-16.

Yassin MA, Datiko DG, Shargie EB. Ten-year experiences of the tuberculosis control program in the southern region of Ethiopia. Int J Lung Dis. 2006;10(10):1166-71.

Arora VK, Gupta R. Trends of extrapulmonary tuberculosis under revised national tuberculosis control program: A study from South Delhi. Ind J Tuberc. 2006;53:77-83.

Rock RB, Sutherland WM, Baker C, Williams DN. Extrapulmonary tuberculosis among Somalis in Minnesota. Emerging infectious diseases. 2006 Sep;12(9):1434.

Tadesse M, Abebe G, Abdissa K, Aragaw D, Abdella K, Bekele A, et al. GeneXpert MTB/RIF assay for the diagnosis of tuberculous lymphadenitis on concentrated fine needle aspirates in high tuberculosis burden settings. PLoS ONE. 2015;10(9):1-9.

Gaur PS, Bhaskar R, Singh S, Saxena P, Agnihotri S. Incidence and clinical profiles of pulmonary and extra-pulmonary tuberculosis patients in North Indian population: a hospital based retrospective study. Inter J Res Development in Pharmacy and Life Science. 2017;6(5):2773-8.

Agrawal M, Bajaj A, Bhatia V, Dutt S. Comparative study of GeneXpert with ZN stain and culture in samples of suspected pulmonary tuberculosis. JCDR. 2016;10(5):9-12.

Lenaerts A, Barry CE, Dartois V. Heterogeneity in tuberculosis pathology, microenvironments and therapeutic responses. Immunological Reviews. 2015;264(1):288-307.

Suzana S, Ninan MM, Gowri M, Venkatesh K, Rupali P, Michael JS.Xpert MTB/Rif for the diagnosis of extrapulmonary tuberculosis-an experience from a tertiary care centre in South India. Trop Med Int Health. 2016 Mar;21(3):385-92.

World Health Organization. Xpert MTB/RIF implementation manual, 2014. Available at: http://www.stoptb.org/wg/gli/assets/documents/M6/Mirzayev%20-%20Implementation%20manual.pdf.

Singh KG, Tandon S, Nagdeote ST, Sharma K, Kumar A. Role of CB-NAAT in diagnosing Mycobacterial tuberculosis and rifampicin resistance in tubercular peripheral lymphadenopathy. Int J Med Res Rev. 2017;5(03):242-46.

Ligthelm LJ, Nicol MP, Hoek KG, Jacobson R, van Helden PD, Marais BJ, et al. Xpert MTB/RIF for rapiddiagnosis of tuberculous lymphadenitis from fine-needle-aspiration biopsy specimens. J Clin Microbiol. 2011;49: 3967-70.