ABSTRACT

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 represents 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 h.

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 optimize the diagnostic yield of Xpert MTB/RIF and Xpert Ultra in EPTB samples. Research is needed to facilitate standardization 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：

---

Xpert MTB/RIF 和 Xpert Ultra 在肺外结核病中的应用。

摘要

介绍

结核病 (TB) 仍然是主要的全球健康负担。通报的事件和估计的事件之间仍然存在很大差距。肺外 (EP) TB 占所有 TB 病例的 15%，由于微生物的缺乏，诊断更具挑战性。涂片显微镜检查通常是不敏感的，并且培养方法会延长。随着 Xpert MTB/RIF 和最近的 Xpert Ultra 的推出，通过提供一个快速可访问的平台来诊断结核病并在 2 小时内识别利福平耐药性，这已经改变了结核病诊断。

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 TB 诊断方面取得了重大进展，但仍需要优化 Xpert MTB/RIF 和 Xpert Ultra 在 EPTB 样本中的诊断率。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 在不同负载设置中的作用。除了目前的 GeneXpert 平台，快速二线耐药聚合酶链反应和全基因组测序的推出可能有助于通过更全面的诊断方法和适当的治疗来应对全球健康负担。