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Diagnostic Approach to Extrapulmonary Tuberculosis by Cartridge-based Nucleic Acid Amplification Test.

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The Cartridge-based nucleic acid amplification test (CBNAAT) significantly improves early diagnosis of extrapulmonary tuberculosis (EPTB). This rapid molecular test accurately identifies EPTB cases missed by traditional smear microscopy.

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Area of Science:

  • Medical Diagnostics
  • Infectious Diseases
  • Molecular Biology

Background:

  • Tuberculosis (TB) remains a global health challenge, with extrapulmonary TB (EPTB) posing diagnostic difficulties due to varied presentations and low bacterial load.
  • Early and accurate diagnosis of EPTB is crucial for effective patient management and disease control.
  • The Cartridge-based nucleic acid amplification test (CBNAAT) offers a rapid and sensitive method for TB detection.

Purpose of the Study:

  • To evaluate the diagnostic utility of CBNAAT for the early detection of extrapulmonary tuberculosis (EPTB).
  • To compare the performance of CBNAAT against conventional smear microscopy in diagnosing EPTB.
  • To assess the identification of rifampicin resistance using CBNAAT in EPTB cases.

Main Methods:

  • A comparative study was conducted over 8 months in a rural tertiary care hospital.
  • Samples from various sites (pleural fluid, lymph nodes, CSF, etc.) were tested using both CBNAAT and fluorescent smear microscopy.
  • Positive samples underwent culture for further analysis and comparison.

Main Results:

  • Out of 593 samples, CBNAAT detected 52 positive EPTB cases, including six with rifampicin resistance.
  • Fluorescent smear microscopy identified only 33 positive samples, highlighting its limitations in EPTB diagnosis.
  • CBNAAT demonstrated superior sensitivity in detecting acid-fast bacilli compared to smear microscopy.

Conclusions:

  • CBNAAT is a highly effective tool for the early and accurate diagnosis of extrapulmonary TB.
  • The test accurately identifies cases that are false negatives by conventional smear microscopy.
  • CBNAAT facilitates prompt initiation of appropriate treatment for EPTB patients.