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Hassan S, Mustafa T, Muller W, Torres L, Marijani M, Ngadaya E, Mfinanga S, Lema Y, Grønningen E, Jorstad M, Norheim O, Robberstad B. Comparing the cost-effectiveness of the MPT64-antigen detection test to Xpert MTB/RIF and ZN-microscopy for the diagnosis of Extrapulmonary Tuberculosis: An economic evaluation modelling study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003414. [PMID: 39116052 PMCID: PMC11309377 DOI: 10.1371/journal.pgph.0003414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 06/04/2024] [Indexed: 08/10/2024]
Abstract
Extrapulmonary Tuberculosis (EPTB) poses challenges from patient and health system perspectives. The cost-effectiveness analysis of the Xpert MTB/RIF (Xpert) test to diagnose pulmonary tuberculosis is documented. However, there are no economic evaluations for EPTB. Considering the reported better diagnostic sensitivity of the MPT64 test, this study explored its cost-effectiveness as an alternative diagnostic test. We conducted this economic evaluation to assess the cost-effectiveness of the MPT64 test compared to Xpert and ZN microscopy for EPTB adult patients. We utilised a Markov modelling approach to capture short- and long-term costs and benefits from a health system perspective. For the model inputs, we combined data from our cohort studies in Tanzania and peer-reviewed EPTB literature. We calculated the Incremental Cost Effectiveness Ratio (ICER) by comparing the cost (in USD) of each diagnostic test and Quality Adjusted Life Years (QALYs) as health gain. We found the MPT64 test cost-effective for EPTB diagnosis and absolutely dominated ZN microscopy and Xpert using the baseline model inputs. A scenario analysis showed that the Xpert test might be the most cost-effective at its higher test sensitivity, which corresponds to using it to diagnose lymph node aspirates. The prevalence of HIV among EPTB cases, their probability of treatment, costs of ART, and the probability of the MPT64 test in detecting EPTB patients were the main parameters associated with the highest impact on ICER in one-way deterministic analysis. The most cost-effective option for EPTB at the baseline parameters was the MPT64 diagnostic test. Including the MPT64 test in EPTB diagnostic pathways for previously untreated patients can lead to better resource use. The Xpert test was the most cost-effective diagnostic intervention at a higher diagnostic test sensitivity in scenario analyses based on different sites of infection, such as for the lymph node aspirates.
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Affiliation(s)
- Shoaib Hassan
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
| | - Tehmina Mustafa
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - William Muller
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
- The United Republic of Tanzania, Mbeya Zonal Referral Hospital, Mbeya, The United Republic of Tanzania
| | - Lisete Torres
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
- The United Republic of Tanzania, Mbeya Zonal Referral Hospital, Mbeya, The United Republic of Tanzania
| | - Msafiri Marijani
- Mnazi Mmoja Referral Hospital, Zanzibar, The United Republic of Tanzania
| | - Esther Ngadaya
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
| | - Sayoki Mfinanga
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
| | - Yakobo Lema
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
| | - Erlend Grønningen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Melissa Jorstad
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Ole Norheim
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Department of Global Public Health and Primary Care, Health Economics, Leadership and Translational Research Group, University of Bergen, Bergen, Norway
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Grønningen E, Nanyaro M, Blomberg B, Hassan S, Ngadaya E, Mustafa T. Mortality among extrapulmonary tuberculosis patients in the HIV endemic setting: lessons from a tertiary level hospital in Mbeya, Tanzania. Sci Rep 2024; 14:10916. [PMID: 38740851 DOI: 10.1038/s41598-024-61589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Extrapulmonary tuberculosis (EPTB) has received less attention than pulmonary tuberculosis due to its non-contagious nature. EPTB can affect any organ and is more prevalent in people living with HIV. Low- and middle-income countries are now facing the double burden of non-communicable diseases (NCDs) and HIV, complicating the management of patients with symptoms that could be compatible with both EPTB and NCDs. Little is known about the risk of death of patients presenting with symptoms compatible with EPTB. We included patients with a clinical suspicion of EPTB from a tertiary level hospital in Mbeya, Tanzania, to assess their risk of dying. A total of 113 (61%) patients were classified as having EPTB, and 72 (39%) as having non-TB, with corresponding mortality rates of 40% and 41%. Associated factors for mortality in the TB groups was hospitalization and male sex. Risk factors for hospitalization was having disease manifestation at any site other than lymph nodes, and comorbidities. Our results imply that NCDs serve as significant comorbidities amplifying the mortality risk in EPTB. To strive towards universal health coverage, focus should be on building robust health systems that can tackle both infectious diseases, such as EPTB, and NCDs.
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Affiliation(s)
- Erlend Grønningen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5020, Bergen, Norway.
- Department of Thoracic Medicine, Haukeland University Hospital, 5021, Bergen, Norway.
| | - Marywinnie Nanyaro
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Bjørn Blomberg
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway
- Department of Medicine, National Center for Tropical Infectious Diseases, Haukeland University Hospital, 5021, Bergen, Norway
| | - Shoaib Hassan
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway
| | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Tehmina Mustafa
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5020, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, 5021, Bergen, Norway
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Helle OMB, Kanthali M, Ishtiaq S, Ambreen A, Purohit MR, Mustafa T. Diagnosing adult and pediatric extrapulmonary tuberculosis by MPT64 antigen detection with immunohistochemistry and immunocytochemistry using reproduced polyclonal antibodies. J Pathol Clin Res 2024; 10:e12373. [PMID: 38572528 PMCID: PMC10993049 DOI: 10.1002/2056-4538.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Immunohistochemistry or immunocytochemistry has been used to diagnose tuberculosis (TB) by detection of MPT64 antigen from various extrapulmonary specimens and has shown good diagnostic performance in our previous studies. The test can distinguish between disease caused by Mycobacterium tuberculosis (Mtb) complex and nontuberculous mycobacteria and can be applied on formalin-fixed paraffin-embedded tissue. As the antibodies previously used were in limited supply, a new batch of polyclonal antibodies was developed for scale-up and evaluated for the first time in this study. Our aim was to assess the diagnostic accuracy of the MPT64 test with reproduced antibodies in the high burden settings of Pakistan and India. Patients were enrolled prospectively. Samples from suspected sites of infection were collected and subjected to histopathologic and/or cytologic evaluation, routine TB diagnostics, GeneXpert MTB/RIF (Xpert), and the MPT64 antigen detection test. Patients were followed until the end of treatment. Based on a composite reference standard (CRS), 556 patients were categorized as TB cases and 175 as non-TB cases. The MPT64 test performed well on biopsies with a sensitivity and specificity of 94% and 75%, respectively, against a CRS. For cytology samples, the sensitivity was low (36%), whereas the specificity was 81%. Overall, the MPT64 test showed higher sensitivity (73%) than Xpert (38%) and Mtb culture (33%). The test performed equally well in adults and children. We found an additive diagnostic value of the MPT64 test in conjunction with histology and molecular tests, increasing the yield for EPTB. In conclusion, immunochemical staining with MPT64 antibodies improves the diagnosis of EPTB in high burden settings and could be a valuable addition to routine diagnostics.
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Affiliation(s)
- Ole Magnus Bjørgaas Helle
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
- Centre for International Health, Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Mala Kanthali
- Department of PathologyR.D. Gardi Medical CollegeUjjainIndia
| | - Sheeba Ishtiaq
- Department of HistopathologyGulab Devi HospitalLahorePakistan
| | - Atiqa Ambreen
- Department of MicrobiologyGulab Devi HospitalLahorePakistan
| | - Manju Raj Purohit
- Department of PathologyR.D. Gardi Medical CollegeUjjainIndia
- Department of Public Health SciencesKarolinska InstitutetStockholmSweden
| | - Tehmina Mustafa
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
- Centre for International Health, Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Olbrich L, Nliwasa M, Sabi I, Ntinginya NE, Khosa C, Banze D, Corbett EL, Semphere R, Verghese VP, Michael JS, Graham SM, Egere U, Schaaf HS, Morrison J, McHugh TD, Song R, Nabeta P, Trollip A, Geldmacher C, Hoelscher M, Zar HJ, Heinrich N. Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease: A Diagnostic Accuracy Study for Pediatric Tuberculosis. Pediatr Infect Dis J 2023; 42:353-360. [PMID: 36854097 PMCID: PMC10097493 DOI: 10.1097/inf.0000000000003853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study. METHODS This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor's and all relevant local ethics committees. DISCUSSION As a diagnostic accuracy study for a disease with an imperfect reference standard, Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB) was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB.
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Affiliation(s)
- Laura Olbrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Marriott Nliwasa
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Issa Sabi
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Nyanda E. Ntinginya
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Denise Banze
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robina Semphere
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Valsan P. Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College (CMC), Vellore, India
| | - Joy Sarojini Michael
- Department of Clinical Microbiology, Christian Medical College (CMC), Vellore, India
| | - Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics, Royal Children’s Hospital, Melbourne, Australia
| | - Uzochukwu Egere
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - H. Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Julie Morrison
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College, London, London, United Kingdom
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Pamela Nabeta
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Andre Trollip
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Christof Geldmacher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Hoelscher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Heather J. Zar
- Department of Paediatrics & Child Health, SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Norbert Heinrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
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Ulain N, Ali A, Khan M, Ullah Z, Shaheen L, Shareef N, Yasir M, Mustafa T. Improving diagnosis of tuberculous lymphadenitis by combination of cytomorphology and MPT64 immunostaining on cell blocks from the fine needle aspirates. PLoS One 2022; 17:e0276064. [PMID: 36228032 PMCID: PMC9560136 DOI: 10.1371/journal.pone.0276064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Extra pulmonary tuberculosis (EPTB) constitutes 18% of all tuberculosis (TB) cases and tuberculous lymphadenitis (TBL) constitutes 20-40% of EPTB. Diagnosis of TBL is challenging because of the paucibacillary nature of the disease. OBJECTIVE To investigate the diagnostic potential of a new antigen detection test based on the detection of M. tuberculosis complex specific antigen MPT64 from fine needle aspirate (FNA) cytology smears and biopsies obtained from patients with clinically suspected TBL using immunohistochemistry (IHC). MATERIALS AND METHODS This study was conducted at Khyber Teaching Hospital and Rehman Medical Institute, Peshawar, Pakistan, from January 2018 to April 2019. Samples, including FNA (n = 100) and biopsies (n = 8), were collected from 100 patients with presumptive TBL. Direct smears and cell blocks were prepared from the FNA samples. All samples were subjected to hematoxylin-eosin (H&E) staining, Ziehl-Neelsen (ZN) staining, and immunostaining with polyclonal anti-MPT64 antibody. The culture was performed only for biopsy specimens. All patients were followed until the completion of anti-TB treatment. The response to treatment was included in the composite reference standard (CRS) and used as the gold standard to validate the diagnostic tests. RESULTS The sensitivity, specificity, positive and negative predictive values for ZN staining were 4.4%,100%,100%,56%, for culture were 66%,100%,100%,50%, for cytomorphology were 100%,90.91%,90%,100%, and for immunostaining with anti-MPT64 were all 100%,respectively. The morphology and performance of immunohistochemistry were better with cell blocks than with smears. CONCLUSION MPT64 antigen detection test performed better than ZN and cytomorphology in diagnosing TBL. This test applied to cell blocks from FNA is robust, simple, and relatively rapid, and improves the diagnosis of TBL.
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Affiliation(s)
- Noor Ulain
- Department of Microbiology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Asif Ali
- Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
- School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Momin Khan
- Department of Microbiology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Zakir Ullah
- Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Lubna Shaheen
- Department of Otolaryngology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Naveed Shareef
- Department of Pathology, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Muhammad Yasir
- Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Tehmina Mustafa
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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Zamir H, Ahmad B, Ali S, Khan SA, Sarwar R, Khan A, Ali J, Khan AA. Molecular characterization of Mycobacterium tuberculosis through MPT64 gene polymorphism using next-generation sequencing technology. Future Microbiol 2022; 17:763-772. [PMID: 35473398 DOI: 10.2217/fmb-2020-0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To characterize and analyze polymorphism of the MPT64 gene and evaluate AgMPT64-based immunochromatographic assay (ICA) specificity associated with polymorphism. Materials & methods: A total of 1449 suspected samples were tested for tuberculosis (TB), and the MPT64/rv1980c gene was sequenced using next-generation sequencing for polymorphism analysis. Results: Of the TB-positive individuals, 200 (13.80%), 186 (12.84%) and 129 (8.90%) were positive using the liquid culture, GeneXpert and fluorescence microscopy assays, respectively. Liquid culture medium-based samples were confirmed using ICA, in which 193 (96.5%) were positive while seven (3.5%) were negative. Out of 14 sequenced samples, seven were positive and seven negative; 13 were identical to the reference and just one (ICA positive) showed a C477A point mutation (F159L). Conclusion: The results indicate that AgMPT64 can be considered as a potent vaccine candidate.
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Affiliation(s)
- Hina Zamir
- Centre of Biotechnology & Microbiology, University of Peshawar, KP, 25120, Pakistan
| | - Bashir Ahmad
- Centre of Biotechnology & Microbiology, University of Peshawar, KP, 25120, Pakistan
| | - Sajid Ali
- Provincial Tuberculosis Reference Laboratory, Peshawar, KP, 25120, Pakistan
| | - Saad A Khan
- Department of Medicine, Kabir Medical College, Peshawar, KP, 25120, Pakistan
| | - Raheela Sarwar
- Centre of Biotechnology & Microbiology, University of Peshawar, KP, 25120, Pakistan
| | - Alamzeb Khan
- Department of Pediatrics, Yale school of Medicine, Yale University, New Haven, CT 06511, USA
| | - Johar Ali
- Centre for Genomics Sciences, Rehman Medical Institute, Peshawar, KP, 25120, Pakistan
| | - Abid A Khan
- Centre of Biotechnology & Microbiology, University of Peshawar, KP, 25120, Pakistan.,Centre for Genomics Sciences, Rehman Medical Institute, Peshawar, KP, 25120, Pakistan.,Department of Chemical Sciences, University of Lakki Marwat, Lakki Marwat, KP, 28420, Pakistan
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Grønningen E, Nanyaro M, Sviland L, Ngadaya E, Muller W, Torres L, Mfinanga S, Mustafa T. Improved diagnosis of extrapulmonary tuberculosis in adults with and without HIV in Mbeya, Tanzania using the MPT64 antigen detection test. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001317. [PMID: 36962852 PMCID: PMC10021170 DOI: 10.1371/journal.pgph.0001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
Extrapulmonary tuberculosis (EPTB) in People Living with HIV (PLWHIV) is a diagnostic challenge. Our immunochemistry based MPT64 antigen detection test has shown improved sensitivity compared to current laboratory tests in the resource limited diagnostic setting. The aim of this study was to validate the implementability and diagnostic performance of the test in PLWHIV and HIV negative adults in a HIV endemic Tanzanian setting. Adult (>18 y) presumptive EPTB patients were prospectively enrolled at Mbeya Zonal Referral Hospital and followed to the end of treatment or until an alternative diagnosis was reached. Suspected sites of infection were sampled and were subject to routine diagnostics, GeneXpert MTB/RIF assay and the MPT64 test. The performance of the diagnostics tests was assessed using a composite reference standard that included clinical suspicion, mycobacterial culture, response to anti-tuberculosis (TB) therapy, cytological and radiological findings. Patients (N = 168) were categorized as 21 confirmed TB, 23 probable TB and 44 possible TB cases, 69 patients were categorized as non-TB cases and 11 were uncategorized. In the TB group, the three most common infections were adenitis (41%), peritonitis (19%) and pleuritis (14%). The TB and non-TB groups did not differ in HIV seropositivity (46% vs 42%) Among HIV negative and PLWHIV, the MPT64 test had a sensitivity of (91% vs 78%), specificity (75% vs 86%), positive predictive value (80% vs 88%), negative predictive value (89% vs 74%), and accuracy (84% vs 81%), respectively. Performance was not significantly reduced in PLWHIV, and sensitivity was higher than in the currently used tests, including the GeneXpert MTB/RIF assay. The MPT64 test improved the diagnosis of EPTB, irrespective of HIV status. The test performed better than currently used diagnostic test. The test was implementable in a tertiary level hospital with basic pathology services in a HIV endemic Tanzanian setting.
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Affiliation(s)
- Erlend Grønningen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Vestland, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Vestland, Norway
| | - Marywinnie Nanyaro
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
| | - Lisbet Sviland
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Vestland, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Vestland, Norway
| | - Esther Ngadaya
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
| | - William Muller
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
- Mbeya Zonal Referral Hospital, Mbeya, The United Republic of Tanzania
| | - Lisete Torres
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
- Mbeya Zonal Referral Hospital, Mbeya, The United Republic of Tanzania
| | - Sayoki Mfinanga
- National Institute for Medical Research, Dar es Salaam, The United Republic of Tanzania
| | - Tehmina Mustafa
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Vestland, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Vestland, Norway
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