Article: Tuberculosis diagnosis in resource-limited settings: Clinical use of GeneXpert in the diagnosis of smear-negative PTB: a case report

Background: The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the diagnosis of tuberculosis and drug resistant-tuberculosis. In resource-limited settings, GeneXpert has been used predominantly for research and there is little experience with its use in day-to-day management of patients.

Case Summary: We describe a case of a 46 year old HIV-infected male with smear-negative pulmonary tuberculosis, who had several visits to various lower level health centres and two admissions in a tertiary care hospital; however, the diagnosis of tuberculosis was only made several months later on GeneXpert testing that was performed under a research project.

Conclusion: GeneXpert facilitated identification of tuberculosis in an HIV positive patient in whom the diagnosis had been delayed when more widely available tests were used. Operational and cost-effectiveness studies are needed to provide evidence to policy makers in order to improve access to GeneXpert.

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References

1.

Helb D, Jones M, Story E, Boehme C, Wallace E, Ho K . Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol. 2009; 48(1):229-37. PMC: 2812290. DOI: 10.1128/JCM.01463-09. View

2.

Getahun H, Harrington M, OBrien R, Nunn P . Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet. 2007; 369(9578):2042-2049. DOI: 10.1016/S0140-6736(07)60284-0. View

3.

Rachow A, Zumla A, Heinrich N, Rojas-Ponce G, Mtafya B, Reither K . Rapid and accurate detection of Mycobacterium tuberculosis in sputum samples by Cepheid Xpert MTB/RIF assay--a clinical validation study. PLoS One. 2011; 6(6):e20458. PMC: 3126807. DOI: 10.1371/journal.pone.0020458. View

4.

Lawn S, Wood R . Tuberculosis in antiretroviral treatment services in resource-limited settings: addressing the challenges of screening and diagnosis. J Infect Dis. 2011; 204 Suppl 4:S1159-67. PMC: 3192543. DOI: 10.1093/infdis/jir411. View

5.

Van Rie A, Page-Shipp L, Scott L, Sanne I, Stevens W . Xpert(®) MTB/RIF for point-of-care diagnosis of TB in high-HIV burden, resource-limited countries: hype or hope?. Expert Rev Mol Diagn. 2010; 10(7):937-46. DOI: 10.1586/erm.10.67. View

Tuberculosis Diagnosis in Resource-limited Settings: Clinical Use of GeneXpert in the Diagnosis of Smear-negative PTB: a Case Report