scholarly journals Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

2015 ◽  
Vol 53 (8) ◽  
pp. 2451-2459 ◽  
Author(s):  
Ashutosh N. Aggarwal ◽  
Ritesh Agarwal ◽  
Dheeraj Gupta ◽  
Sahajal Dhooria ◽  
Digambar Behera
Keyword(s):  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Interferon Gamma ◽  
Whole Blood ◽  
Meta Analysis ◽  
Extrapulmonary Tuberculosis ◽  
Latent Tuberculosis ◽  
Summary Receiver Operating Characteristic ◽  
Interferon Gamma Release Assays ◽  
Meta Regression

The role of interferon gamma release assays (IGRAs), although established for identifying latent tuberculosis, is still evolving in the diagnosis of active extrapulmonary tuberculosis. We systematically evaluated the diagnostic performance of blood- and pleural fluid-based IGRAs in tuberculous pleural effusion (TPE). We searched the PubMed and Embase databases for studies evaluating the use of commercially available IGRAs on blood and/or pleural fluid samples for diagnosing TPE. The quality of the studies included was assessed through the QUADAS-2 tool. The pooled estimates of sensitivity and specificity with 95% confidence intervals (95% CI) were generated using a bivariate random-effects model and examined using forest plots and hierarchical summary receiver operating characteristic (HSROC) curves. Indeterminate IGRA results were included for sensitivity calculations. Heterogeneity was explored through subgroup analysis and meta-regression based on prespecified covariates. We identified 19 studies assessing the T.SPOT.TB and/or QuantiFERON assays. There were 20 and 14 evaluations, respectively, of whole-blood and pleural fluid assays, involving 1,085 and 727 subjects, respectively. There was only one good-quality study, and five studies used nonstandard assay thresholds. The pooled sensitivity and specificity for the blood assays were 0.77 (95% CI, 0.71 to 0.83) and 0.71 (95% CI, 0.65 to 0.76), respectively. The pooled sensitivity and specificity for the pleural fluid assays were 0.72 (95% CI, 0.55 to 0.84) and 0.78 (95% CI, 0.65 to 0.87), respectively. There was considerable heterogeneity; however, multivariate meta-regression did not identify any covariate with significant influence. There was no publication bias for blood assays. We conclude that commercial IGRAs, performed either on whole-blood or pleural fluid samples, have poor diagnostic accuracy in patients suspected to have TPE.

scholarly journals Comparative accuracy of pleural fluid unstimulated interferon-gamma and adenosine deaminase for diagnosing pleural tuberculosis: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253525
Author(s):  
Ashutosh Nath Aggarwal ◽  
Ritesh Agarwal ◽  
Sahajal Dhooria ◽  
Kuruswamy Thurai Prasad ◽  
Inderpaul Singh Sehgal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Interferon Gamma ◽  
Meta Analysis ◽  
Paired Data ◽  
Ifn Γ ◽  
Meta Regression

Objective We compared diagnostic accuracy of pleural fluid adenosine deaminase (ADA) and interferon-gamma (IFN-γ) in diagnosing tuberculous pleural effusion (TPE) through systematic review and comparative meta-analysis. Methods We queried PubMed and Embase databases to identify studies providing paired data for sensitivity and specificity of both pleural fluid ADA and IFN-γ for diagnosing TPE. We used hierarchical summary receiver operating characteristic (HSROC) plots and HSROC meta-regression to model individual and comparative diagnostic performance of the two tests. Results We retrieved 376 citations and included 45 datasets from 44 publications (4974 patients) in our review. Summary estimates for sensitivity and specificity for ADA were 0.88 (95% CI 0.85–0.91) and 0.91 (95% CI 0.89–0.92), while for IFN-γ they were 0.91 (95% CI 0.89–0.94) and 0.96 (95% CI 0.94–0.97), respectively. HSROC plots showed consistently greater diagnostic accuracy for IFN-γ over ADA across the entire range of observations. HSROC meta-regression using test-type as covariate yielded a relative diagnostic odds ratio of 2.22 (95% CI 1.68–2.94) in favour of IFN-γ, along with better summary sensitivity and specificity figures. No prespecified subgroup variable significantly influenced the summary diagnostic accuracy estimates. Conclusion Pleural fluid IFN-γ estimation has better diagnostic accuracy than ADA estimation for diagnosis of TPE.

scholarly journals Xpert MTB/RIF assay for diagnosis of extrapulmonary tuberculosis in children: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Young Seok Seo ◽  
Ji-Man Kang ◽  
Dong Soo Kim ◽  
Jong Gyun Ahn
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Sampling Site ◽  
Extrapulmonary Tuberculosis ◽  
Antibiotic Sensitivity ◽  
High Specificity ◽  
Nucleic Acid Amplification ◽  
Summary Receiver Operating Characteristic ◽  
Amplification Assay ◽  
Tuberculosis In Children

Abstract Background The Xpert® MTB/RIF assay (Xpert; Cepheid, Sunnyvale, CA, USA) is a cartridge-based nucleic acid amplification assay for rapidly diagnosing tuberculosis and assessing antibiotic sensitivity. Although previous evidence supports the use of Xpert for diagnosing extrapulmonary tuberculosis (EPTB) in adults, information regarding the accuracy of Xpert for EPTB only in children is lacking. This meta-analysis was performed to assess the accuracy of Xpert for detecting EPTB in children. Methods We searched the MEDLINE, EMBASE, and Cochrane Infectious Diseases Group Specialized Register from January 1, 2010 to July 16, 2019 for studies of the diagnostic performance wherein Xpert was analyzed against cultures or composite reference standards for < 18-year-old children with EPTB. Results In only pediatric studies, 8 studies including 652 samples were selected. The pooled sensitivity and specificity of Xpert for all samples were 71% (95% CI 0.63–0.79) and 97% (95% CI 0.95–0.99), respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.89. For lymph node tissues or aspirates, the pooled sensitivity and specificity of Xpert were 80% (95% CI 0.70–0.88) and 94% (95% CI 0.89–0.97), respectively; for cerebrospinal fluid (CSF), these values were 42% (95% CI 0.22–0.63) and 99% (95% CI 0.95–1.00), respectively. Conclusion Overall, Xpert displayed high specificity but modest sensitivity across various samples for diagnosing pediatric EPTB compared to the composite reference standard. Xpert sensitivity varied with the sampling site and was especially lower in CSF samples. Positive Xpert results may be considered to indicate a presumptive case of pediatric EPTB, whereas negative test results indicate that the possibility of pediatric EPTB should not be excluded.

scholarly journals The Clinical Usefulness of Tuberculin Skin Test versus Interferon-Gamma Release Assays for Diagnosis of Latent Tuberculosis in HIV Patients: A Meta-Analysis

PLoS ONE ◽  
2016 ◽  
Vol 11 (9) ◽  
pp. e0161983 ◽  
Author(s):  
Erfan Ayubi ◽  
Amin Doosti-Irani ◽  
Ali Sanjari Moghaddam ◽  
Mohadeseh Sani ◽  
Milad Nazarzadeh ◽  
...  
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Interferon Gamma ◽  
Meta Analysis ◽  
Latent Tuberculosis ◽  
Clinical Usefulness ◽  
Hiv Patients ◽  
Interferon Gamma Release Assays

scholarly journals Xpert MTB/RIF assay for diagnosis of extrapulmonary tuberculosis in children: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Young Seok Seo ◽  
Ji-Man Kang ◽  
Dong Soo Kim ◽  
Jong Gyun Ahn
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Sampling Site ◽  
Extrapulmonary Tuberculosis ◽  
Antibiotic Sensitivity ◽  
High Specificity ◽  
Nucleic Acid Amplification ◽  
Summary Receiver Operating Characteristic ◽  
Amplification Assay ◽  
Tuberculosis In Children

Abstract Background: The Xpert® MTB/RIF assay (Xpert; Cepheid, Sunnyvale, CA, USA) is a cartridge-based nucleic acid amplification assay for rapid tuberculosis diagnosis and assessment of antibiotic sensitivity. Although previous evidence supports the use of Xpert for diagnosing extrapulmonary tuberculosis (EPTB) in adults, information regarding the accuracy of Xpert for EPTB only in children is lacking. This meta-analysis aimed to assess the accuracy of Xpert for detecting EPTB in children. Methods: We searched the MEDLINE, EMBASE, and the Cochrane Infectious Diseases Group Specialized Register from January 1, 2010, to July 16, 2019, for studies on diagnostic performance wherein Xpert was analyzed against cultures or composite reference standards for <18-year-old children with EPTB. Results: Exclusively on the basis of pediatric studies, 7 studies including 560 samples were selected. The pooled sensitivity and specificity of Xpert for all samples were 67% (95% CI 0.51-0.79) and 94% (95% CI 0.87-0.98), respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.89. For lymph node tissues or aspirates, the pooled sensitivity and specificity of Xpert were 75% (95% CI 0.54-0.89) and 90% (95% CI 0.77-0.96), respectively; for cerebrospinal fluid (CSF), they were 40% (95% CI 0.23-0.60) and 96% (95% CI 0.85-0.99), respectively. Conclusion: Overall, Xpert displayed high specificity but modest specificity across various samples in the diagnosis of pediatric EPTB in comparison with the composite reference standard. Xpert sensitivity varied with the sampling site, and was especially lower for CSF samples. Positive Xpert results may be considered to indicate a presumptive case of pediatric EPTB, whereas negative test results indicate that the possibility of pediatric EPTB should not be excluded.

scholarly journals Xpert MTB/RIF assay for diagnosis of extrapulmonary tuberculosis in children: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Young Seok Seo ◽  
Ji-Man Kang ◽  
Dong Soo Kim ◽  
Jong Gyun Ahn
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Sampling Site ◽  
Extrapulmonary Tuberculosis ◽  
Antibiotic Sensitivity ◽  
High Specificity ◽  
Nucleic Acid Amplification ◽  
Summary Receiver Operating Characteristic ◽  
Amplification Assay ◽  
Tuberculosis In Children

Abstract Background: The Xpert® MTB/RIF assay (Xpert; Cepheid, Sunnyvale, CA, USA) is a cartridge-based nucleic acid amplification assay for rapidly diagnosing tuberculosis and assessing antibiotic sensitivity. Although previous evidence supports the use of Xpert for diagnosing extrapulmonary tuberculosis (EPTB) in adults, information regarding the accuracy of Xpert for EPTB only in children is lacking. This meta-analysis was performed to assess the accuracy of Xpert for detecting EPTB in children. Methods: We searched the MEDLINE, EMBASE, and Cochrane Infectious Diseases Group Specialized Register from January 1, 2010 to July 16, 2019 for studies of the diagnostic performance wherein Xpert was analyzed against cultures or composite reference standards for <18-year-old children with EPTB. Results: In only pediatric studies, 8 studies including 652 samples were selected. The pooled sensitivity and specificity of Xpert for all samples were 71% (95% CI 0.63–0.79) and 97% (95% CI 0.95–0.99), respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.89. For lymph node tissues or aspirates, the pooled sensitivity and specificity of Xpert were 80% (95% CI 0.70–0.88) and 94% (95% CI 0.89–0.97), respectively; for cerebrospinal fluid (CSF), these values were 42% (95% CI 0.22–0.63) and 99% (95% CI 0.95–1.00), respectively. Conclusion: Overall, Xpert displayed high specificity but modest sensitivity across various samples for diagnosing pediatric EPTB compared to the composite reference standard. Xpert sensitivity varied with the sampling site and was especially lower in CSF samples. Positive Xpert results may be considered to indicate a presumptive case of pediatric EPTB, whereas negative test results indicate that the possibility of pediatric EPTB should not be excluded.

Identifying latent tuberculosis in high-risk populations: systematic review and meta-analysis of test accuracy

2019 ◽  
Vol 23 (11) ◽  
pp. 1178-1190
Author(s):  
P. Auguste ◽  
J. Madan ◽  
A. Tsertsvadze ◽  
R. Court ◽  
N. McCarthy ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Latent Tuberculosis ◽  
Lower Sensitivity ◽  
Test Accuracy ◽  
Interferon Gamma Release Assays ◽  
Credible Intervals ◽  
High Risk Populations

BACKGROUND: The relative accuracy of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) in identifying latent tuberculosis infection (LTBI) is uncertain.OBJECTIVE: To perform a systematic review and meta-analysis to compare the sensitivity and specificity of IGRAs and TST for the prediction of progression to clinical tuberculosis (TB).METHODS: We searched electronic databases (e.g., MEDLINE and EMBASE) from December 2009 to September 2018 for prospective studies that followed up individuals who had undergone testing with commercial IGRAs and/or TST but had not received treatment based on the test result. The sensitivity and specificity estimates were pooled using a Bayesian bivariate random-effects model.RESULTS: Twenty-five studies, mostly with moderate to high risk of bias and a mean follow-up time ranging from 1 to 5 years were included. TST (10–15 mm) tended to have lower sensitivity and higher specificity than QuantiFERON® Gold In-Tube, T-SPOT®.TB and TST (5 mm). The evidence did not indicate that any test outperformed the others due to wide and overlapping 95% credible intervals.CONCLUSION: The evidence following individuals who had undergone testing for LTBI and had progressed to clinical TB is sparse. We did not find that IGRAs were superior to TST or vice versa; however, as our findings are based on a small number of studies with methodological limitations and great uncertainty around the pooled estimates, the results should be interpreted with caution.

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