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. 2021 Sep 2;41(5):1023–1028. doi: 10.1007/s11596-021-2404-4

Comparison of LAMP, GeneXpert, Mycobacterial Culture, Smear Microscopy, TSPOT.TB, TBAg/PHA Ratio for Diagnosis of Pulmonary Tuberculosis

Yan Deng 1, Yi-fei Duan 1, Shu-pei Gao 1, Jian-miao Wang 1,2,✉
PMCID: PMC8412392  PMID: 34476662

Abstract

Objective

To investigate the application value of loop-mediated isothermal amplification (LAMP), GeneXpert, mycobacterial culture, smear microscopy, TSPOT.TB (TSPOT), ratio of TB-specific antigen to phytohemagglutinin (TBAg/PHA ratio) in the detection of mycobacterium tuberculosis in the bronchoalveolar lavage fluid.

Methods

A retrospective analysis was performed on the patients who underwent bronchoscopy from December 2018 to November 2019 in Tongji Hospital. The patients with positive tuberculosis culture or positive GeneXpert in bronchoalveolar lavage fluid were selected as the case group, and those without tuberculosis served as the control group. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of LAMP, GeneXpert, culture, smear microscopy, TSPOT, and TBAg/PHA ratio.

Results

For the patients with positive cultures as case, the sensitivity of LAMP, GeneXpert, smear microscopy, TSPOT and TBAg/PHA ratio was 73.49%, 89.16%, 25.30%, 80.00%, 33.85%, respectively, the specificity was 99.00%, 100.00%, 99.00%, 86.00%, 100.00%, respectively, the area under the ROC curve (AUC) was 0.849, 0.938, 0.633, 0.830, 0.669, respectively. For the patients with positive GeneXpert as case, the sensitivity of LAMP, mycobacterial culture, smear microscopy, TSPOT and TBAg/PHA ratio was 73.20%, 74.23%, 22.68%, 68.92%, 29.73%, respectively, the specificity was 99.00%, 100.00%, 99.00%, 86.00%, 100.00%, respectively, the AUC was 0.853, 0.878, 0.623, 0.775, 0.649, respectively.

Conclusion

The sensitivity of GeneXpert was best. The sensitivity and diagnostic value of LAMP were slightly lower than those of GeneXpert, and were similar to tuberculosis culture. The sensitivity of smear microscopy was low. The specificity of TSPOT was low. When TBAg/PHA ratio >0.2 was used as a diagnostic index, the specificity was improved, but the sensitivity was low.

Key words: pulmonary tuberculosis, bronchoalveolar lavage fluid, loop-mediated isothermal amplification, GeneXpert, TSPOT

Footnotes

Conflict of Interest Statement

All authors declare no conflict of interest.

Contributor Information

Yan Deng, Email: dy102398@163.com.

Jian-miao Wang, Email: wangjianmiao2010@126.com.

References

  • 1.World Health Organization(2019) Global tuberculosis report 2019. Geneva: WHO; 2019. [Google Scholar]
  • 2.World Health Organization(2018) Global tuberculosis report 2018. Geneva: WHO; 2018. [Google Scholar]
  • 3.Pang Y, Du J, Qin ZZ, et al. An overview on tuberculosis-specific hospitals in China in 2009: results of a national survey. Eur Respir J. 2016;47(5):1584–1587. doi: 10.1183/13993003.01854-2015. [DOI] [PubMed] [Google Scholar]
  • 4.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):1067–1082. doi: 10.2217/fmb.11.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Notomi T, Okayama H, Masubuchi H, et al. Loopmediated isothermal amplification of DNA. Nucleic Acids Res. 2000;28(12):E63. doi: 10.1093/nar/28.12.e63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Rudeeaneksin J, Bunchoo S, Srisungngam S, et al. Rapid identification of Mycobacterium tuberculosis in BACTEC MGIT960 cultures by in-house loop-medicated isothermal amplification. Jpn J Infect Dis. 2012;65(4):306–311. doi: 10.7883/yoken.65.306. [DOI] [PubMed] [Google Scholar]
  • 7.Ou X, Li Q, Xia H, et al. Diagnostic accuracy of the PURE-LAMP test for pulmonary tuberculosis at the county-level laboratory in China. PLoS One. 2014;9(5):e94544. doi: 10.1371/journal.pone.0094544. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Neonakis IK, Spandidos DA, Petinaki E. Use of loopmediated isothermal amplification of DNA for the rapid detection of Mycobacterium tuberculosis in clinical specimens. Eur J Clin Microbiol Infect Dis. 2011;30(8):937–942. doi: 10.1007/s10096-011-1195-0. [DOI] [PubMed] [Google Scholar]
  • 9.Wang S, Zhang WH. New progress on diagnosis of tuberculosis. J Microbes Infect. 2016;11(3):188–192. [Google Scholar]
  • 10.Wang F, Hou HY, Wu SJ, et al. Using the TBAg/PHA ratio in the T-SPOT(®).TB assay to distinguish TB disease from LTBI in an endemic area. Int J Tuberc Lung Dis. 2016;20(4):487–493. doi: 10.5588/ijtld.15.0756. [DOI] [PubMed] [Google Scholar]
  • 11.Wang T, Tan YJ, Wu SJ, et al. The ratio of tuberculosis-specific antigen to phytohemagglutinin in T-SPOT assay in the diagnosis of active tuberculosis. Chin J Tuberc Respir Dis. 2019;42(4):262–267. doi: 10.3760/cma.j.issn.1001-0939.2019.04.003. [DOI] [PubMed] [Google Scholar]
  • 12.National Health and Family Planning Commission of the People’s Republic of China . Diagnosis for pulmonary tuberculosis. WS: The health industry standard of the People’s Republic of China; 2017. pp. 288–2017. [Google Scholar]
  • 13.Song QZ, Li H, Shao H, et al. MicmRNA-365 in macrophages regulates mycobacterium-induced active pulmonary tuberculosis via inteleukin-6. Int J Clin Exp Med. 2015;8(9):15 458–15 465. [PMC free article] [PubMed] [Google Scholar]
  • 14.Bodal VK, Bal MS, Bhagat S, et al. Fluorescent microscopy and Ziehl-Neelson staining of brochoalveolar lavage, bronchial washings, brochoscpic brushing and post bronchoscopic sputum along with cytological examination in cases of suspectec tuberculosis. Indial J Pathol Microbiol. 2015;58(4):443–447. doi: 10.4103/0377-4929.168849. [DOI] [PubMed] [Google Scholar]
  • 15.Steingart KR, Henry M, Ng V, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006;6:570e81. doi: 10.1016/S1473-3099(06)70578-3. [DOI] [PubMed] [Google Scholar]
  • 16.Xu P, Tang P, Song HF, et al. The incremental value of bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in a high-burden urban setting. J Infect. 2019;79(1):24–29. doi: 10.1016/j.jinf.2019.05.009. [DOI] [PubMed] [Google Scholar]
  • 17.Liu X, Hou XF, Gao L, et al. Indicators for prediction of Mycobacterium tuberculosis positivity detected with bronchoalveolar lavage fluid. Infect Dis Poverty. 2018;7(1):22. doi: 10.1186/s40249-018-0403-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.World Health Organization(2013) Automated realtime 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. [PubMed] [Google Scholar]
  • 19.Boehme CC, Nabeta P, Hillemann D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010;363(11):1005–1015. doi: 10.1056/NEJMoa0907847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Steingart KR, Sohn H, Schiller I, et al. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev, 2013, (1):CD009593 [DOI] [PMC free article] [PubMed]
  • 21.Boehme CC, Nicol MP, Nabeta P, et al. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet. 2011;377(9776):1495–1505. doi: 10.1016/S0140-6736(11)60438-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Lee HY, Seong MW, Park SS, et al. Diagnostic accuracy of Xpert® MTB/RIF on bronchoscopy specimens in patients with suspected pulmonary tuberculosi. Int J Tuberc Lung Dis. 2013;17(7):917–921. doi: 10.5588/ijtld.12.0885. [DOI] [PubMed] [Google Scholar]
  • 23.Pan X, Yang S, Deighton MA, et al. A Comprehensive Evaluation of Xpert MTB/RIF Assay with Bronchoalveolar Lavage Fluid as a Single Test or Combined with Conventional Assays for Diagnosis of Pulmonary Tuberculosis in China: A Two-Center Prospective Study. Front Microbiol. 2018;9:444. doi: 10.3389/fmicb.2018.00444. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Boehme CC, Nabeta P, Henostroza G, et al. Operational feasibility of using loop-mediated isothermal amplification for diagnosis of pulmonary tuberculosis in microscopy centers of developing countries. J Clin Microbiol. 2007;45(6):1936–1940. doi: 10.1128/JCM.02352-06. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Bojang AL, Mendy FS, Tientcheu LD, et al. Comparison of TB-LAMP, GeneXpert MTB/RIF and culture for diagnosis of pulmonary tuberculosis in The Gambia. J Infect. 2016;72(3):332–337. doi: 10.1016/j.jinf.2015.11.011. [DOI] [PubMed] [Google Scholar]
  • 26.Shete PB, Farr K, Strnad L, et al. Diagnostic accuracy of TB-LAMP for pulmonary tuberculosis: a systematic review and meta-analysis. BMC Infect Dis. 2019;19(1):268. doi: 10.1186/s12879-019-3881-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Wang H, Liu QX, Chen L, et al. Evaluation of LAMP method in detecting BALF specimens from patients clinically diagnosed with pulmonary tuberculosis. Int J Lab Med. 2019;40(7):783–786. [Google Scholar]

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