Gene Xpert: The Xpert Test to Detect MDR-TB(Multi-Drug-Resistant Tuberculosis)

Gene Xpert Machine

Introduction:

This test is used to diagnose active MTB(Mycobacterium Tuberculosis) with Rifampicin resistance at initial stage. This test is developed by FIND(Foundation for Innovative New Diagnotics) with some parteners. This is a WHO endorsed test performed by fully automated NAAT(Nucleic Acid Amplification Test) and can be performed in less than 2 hours. It detect 98-100% of smear +ve cases and 72- 90% of smear -ve cases.

Other Names: CB-NAAT (Cartridge Based Nucleic Acid Amplification Test), Xpert MTB/RIF

Alarming Situation:

WHO estimates that 5% of TB cases are multidrug-resistant and about 9% of MDR - TB patients develop XDR - TB, which is even more difficult to treat.

Features of Gene Xpert:

1. First Choice: Xpert MTB/RIF: used as an initial test replacing phenotypic DST & detected 95% of rifampicin-resistant TB cases.

2. Reliable: Compared to culture, Xpert MTB/RIF detected 88% of TB cases with high specificity (99%).

3. Validated for EPTB: Xpert MTB/RIF may be used as a replacement for testing of non respiratory specimens in patients presumed to have extra-pulmonary TB.

4. Detect rpoB Gene Mutation: Detects rpoB gene mutation responsible for Rifampicin resistance

5. In Case of AFB smear negative sample can be use

6. Upto 95% of Rifampicin-resistant M.tuberculosis strains are also Isoniazid resistant which is an excellent surrogate marker for MDR-TB.

Features of Gene Xpert Machine:

1. Closed cartridge system

2. Results in 2 hours

3. Random access

Comparison with AFB Smear Microscopy Test:
1. Gene Xpert has a higher sensitivity than AFB smear microscopy.
2. 45% Higher detection as compared to smear microscopy in HIV infected patients before starting ART*

Specimen use: Sputum, Bal fluid, Lymph node aspirate or biopsy, Ascites fluid, peritoneal biopsy, Pleural fluid, pleural biopsy, Endometrial tissue, Bone/synovial tissue via biopsy, Cerebrospinal fluid(CSF)

FAQ:

Q1. How Gene Xpert Test detect TB Bacteria and resistance to Riafampicin?
Answer: This test detect DNA in Tb Bacteria and also it detect genetic mutation which detect rifampicin resistance. For example if rPOB gene is detected by Gene xpert machine, so it will be Rifampicin resistance TB.

References:
1. WHO Policy Update 2013
2. ISTC, 3rd Ed, Lancet Resp Med 2015
3. Steingart KR et al. Cochrane Database of systematic reviews, 2014
4. Xpert MTB RIF for the Diagnosis of pulmonary and extrapulmonary TB - WHO Policy Update 2014
5. J5 Clin Microbial Jun 2011; 49(6): 2290-2292
6. http://tbevidence.org
* Anti Retroviral Therapy
7.https://www.youtube.com/watch?v=8G7VGXco4Vs

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