Introduction

Tuberculosis (TB) remains a major global health burden. There still remains a large gap between the notified and estimated incident cases. Extrapulmonary (EP) TB represent 15% of all TB cases and the diagnosis is more challenging due to the paucity of the organism. Smear microscopy is often insensitive and culture methods are prolonged. With the introduction of Xpert MTB/RIF and more recently Xpert Ultra, this has changed TB diagnostics by providing a rapid accessible platform to diagnose TB and identify rifampicin resistance within 2 hours.

Areas covered

The diagnostic accuracy and the clinical role of Xpert MTB/RIF and Xpert Ultra in the different forms of EPTB.

Expert opinion

Whilst significant advances have been made in TB diagnostics, there is still a need to optimise the diagnostic yield of Xpert MTB/RIF and Xpert Ultra in EPTB samples. Research is needed to facilitate standardisation and optimal preparation of samples as well as understanding the role of Xpert MTB/RIF and Xpert Ultra in different burden settings. Alongside the current GeneXpert platform, the launch of rapid second line drug resistance polymerase chain reactions and whole genome sequencing may help tackle the global health burden with a more comprehensive diagnostic approach and appropriate treatment.

中文翻译：

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Xpert MTB / RIF和Xpert Ultra在肺外结核中的应用

介绍

结核病（TB）仍然是全球主要的健康负担。通报的事件和估计的事件之间仍然有很大的差距。肺外（EP）结核占所有结核病例的15％，并且由于该微生物的缺乏，诊断更具挑战性。涂片显微镜检查通常不敏感，并且培养方法会延长。随着Xpert MTB / RIF的推出以及最近的Xpert Ultra的推出，这已经改变了结核病诊断，因为它提供了一个可快速访问的平台来在2小时内诊断结核病和鉴定利福平耐药性。

覆盖区域

Xpert MTB / RIF和Xpert Ultra在不同形式的EPTB中的诊断准确性和临床作用。

专家意见

尽管在结核病诊断方面取得了重大进展，但仍需要优化EPTB样品中Xpert MTB / RIF和Xpert Ultra的诊断产率。需要进行研究以促进样品的标准化和最佳制备，以及了解Xpert MTB / RIF和Xpert Ultra在不同负担设置中的作用。除了当前的GeneXpert平台外，快速二线耐药性聚合酶链反应和全基因组测序的推出可能通过更全面的诊断方法和适当的治疗方法来帮助解决全球健康负担。