Performance of GeneXpert MTB/RIF in the diagnosis of extrapulmonary tuberculosis in Morocco

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Abstract

Tuberculosis (TB), a chronic bacterial disease caused by Mycobacterium tuberculosis, commonly affects the lung but can also affect other parts of the body (extrapulmonary tuberculosis, EPT). A rapid diagnosis is essential to initiate a specific and effective treatment. Although mycobacterial culture remains the gold standard for EPT diagnosis, molecular tools are attracting increasing interest. GeneXpert MTB/RIF, a rapid automated diagnostic test, allows the detection of Mycobacterium tuberculosis as well as mutations in the hot-spot region of the rpoB gene associated with Rifampicin resistance. The present study was performed to evaluate the performance of the GeneXpert MTB/RIF test for the diagnosis of EPT compared to the standard method. This prospective study was conducted on 304 clinical samples collected from 192 patients attending the Laboratory of Mycobacteria and Tuberculosis of Pasteur Institute of Morocco, between 2016 and 2017. Out of the 304 samples, 113 were pleural f luids decontaminated using the Petroff method and 191 were biopsies (78 lymph nodes and 113 pleural biopsies) decontaminated using the Löwenstein method. Mycobacterium tuberculosis detection and identification were performed on all samples using smear microscopy, Löwenstein–Jensen medium culture and the GeneXpert MTB/RIF test. Our results showed that 54.5 (103/189) were men and 45.5% (86/189) were women. The age of patients ranged from 2–78 years and the majority of patients was in the age group 25–45 years. Extrapulmonary samples were derived from lymph nodes, pleural f luids and pleural tissues, with a percentage of 25.66, 37.17 and 37.17%, respectively. Interestingly, the sensitivity of the GeneXpert was 51.4 for all samples and 83.3% for lymph nodes. In conclusion, the present study revealed that the performance of the GeneXpert test depends highly on the type of sample, with a high sensitivity observed for lymph nodes. Additionally, we clearly showed that the GeneXpert MTB/RIF test presents limitations in the diagnosis of pleural TB. Thus, we recommend the coupled use of the GeneXpert MTB/RIF and the conventional techniques for EPT diagnosis.

About the authors

A. Aainouss

Hassan II University; Morocco Pasteur Institute

Author for correspondence.
Email: achraf.aainouss@gmail.com

Achraf Aainouss - PhD Student, Medical Biology Center, Laboratory of Mycobacteria and Tuberculosis, Morocco Pasteur Institute; PhD Student, Department of Biology, Laboratory of Ecology and Environment, Microbiology Unit, Faculty of Science Ben M’Sik, Hassan II University.

27182, Casablanca, Nouaceur, rue Tarik Ibn Ziad, 19.

Phone: +212 611-42-48-19.

Morocco

Gh. Momen

Hassan II University; Morocco Pasteur Institute

Email: Momenghizlane2016@gmail.com

Ghizlane Momen - PhD Student, Medical Biology Center, Laboratory of Mycobacteria and Tuberculosis, Morocco Pasteur Institute; PhD Student, Laboratory of Microbiology, Pharmacology, Biotechnology and Environment, Faculty of Science Ain Chock, Hassan II University.

Casablanca.

Morocco

A. Belghiti

Hassan II University

Email: Belghiti.ayoub@gmail.com

Ayoub Belghiti - PhD, Laboratory of Ecology and Environment, Microbiology Unit, Faculty of Science Ben M’Sik, Hassan II University.

Casablanca.

Morocco

K. Bennani

Ministry of Health

Email: kenzabennani20@gmail.com

Kenza Bennani - MD, MPh, Department of Epidemiology and Disease Control, Ministry of Health.

Rabat.

Morocco

A. Lamaammal

Morocco Pasteur Institute

Email: abdelmajid.lamaammal@pasteur.ma

Abdelmajid Lamaammal - Engineer, Laboratory of Mycobacteria and Tuberculosis, Morocco Pasteur Institute.

Casablanca.

Morocco

F. Chetioui

Morocco Pasteur Institute

Email: chetioui.fouad@gmail.com

Fouad Chetioui - Engineer, Laboratory of Mycobacteria and Tuberculosis, Morocco Pasteur Institute.

Casablanca.

Morocco

M. Messaoudi

Morocco Pasteur Institute

Email: malika.messaoudi@pasteur.ma

Malika Messaoudi - Engineer, Laboratory of Mycobacteria and Tuberculosis, Morocco Pasteur Institute.

Casablanca.

Morocco

M. Blaghen

Hassan II University; University Couaib Doukkali

Email: blaghen@hotmail.com

Mohamed Blaghen - Head of the Laboratory of Microbiology, Pharmacology, Biotechnology and Environment, Faculty of Science Ain Chock, Hassan II University; Dean of the Faculty of Sciences El Jadida, University Chouaib Doukkali.

Casablanca; El Jadida.

Morocco

J. Mouslim

Hassan II University

Email: jammouslim@yahoo.fr

Jamal Mouslim - PhD, Professor, Laboratory of Ecology and Environment, Microbiology Unit, Faculty of Science Ben M’Sik, Hassan II University.

Casablanca.

Morocco

M. Khyatti

Morocco Pasteur Institute

Email: meriem.khyatti@pasteur.ma

Meriem Khyatti - PhD, Leading Researcher, Laboratory of Viral Oncology, Morocco Pasteur Institute.

Casablanca.

Morocco

M. D. El Messaoudi

Morocco Pasteur Institute

Email: mydriss.elmessaoudi@gmail.com

Moulay Driss El Messaoudi - MD, MPh, Head of Laboratory of Mycobacteria and Tuberculosis, Morocco Pasteur Institute.

Casablanca.

Morocco

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Copyright (c) 2021 Aainouss A., Momen G., Belghiti A., Bennani K., Lamaammal A., Chetioui F., Messaoudi M., Blaghen M., Mouslim J., Khyatti M., El Messaoudi M.D.

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