New Evidence Available
Updated Recommendation
A new evidence synthesis was published:2020, WHO consolidated guidelines on tuberculosis: module 3: diagnosis – rapid diagnostics for tuberculosis detection: web annex 2. GRADE profiles
View latest version (2020)Bibliographic information
GuidelineWHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB/RIF ultra compared to Xpert MTB/RIF
Year of Publication2017
Issuing InstitutionWHO
Recommendation
Retired
Originally developed
Xpert MTB/RIF should be used in preference to conventional microscopy and culture as the initial diagnostic test for cerebrospinal fluid specimens from patients suspected of having TB meningitis
Recommended in favor
Strong
Certainty of evidence
Very low
Notes and Remarks
- 1)Individuals suspected of having extrapulmonary TB but who have had a single negative result from Xpert MTB/RIF should undergo further diagnostic testing, and those for whom there is a high clinical suspicion for TB (especially children) should be treated even if an Xpert MTB/RIF result is negative or if the test is not available.
- 2)For CSF specimens, Xpert MTB/RIF should be preferentially used instead of culture if the sample volume is low or if additional specimens cannot be obtained in order to make a quick diagnosis. If sufficient volume of material is available, concentration methods should be used to increase the yield.
- 3)Pleural fluid is a suboptimal sample for the bacterial confirmation of pleural TB regardless of the method used. A pleural biopsy is the preferred sample. The sensitivity of Xpert MTB/RIF in testing samples of pleural fluid is very low. Nevertheless, any individual with a positive result from pleural fluid tested by Xpert MTB/RIF should be treated for pleural TB; those with a negative result from Xpert MTB/RIF should have other tests.
- 4)Conventional microscopy and culture are essential for monitoring therapy and for performing DST for anti-TB agents other than rifampicin (including for isoniazid and second-line anti-TB agents).
- 5)Emerging data have shown that Xpert MTB/RIF detects some rifampicin-resistant strains that are found to be susceptible by phenotypic DST. Sequencing these discordant results usually resolves in favour of Xpert MTB/RIF, and patients missed by phenotypic DST have poor treatment outcomes on first-line treatment.
- 6)These recommendations do not apply to samples of stool, urine or blood, given the lack of data on the utility of Xpert MTB/RIF for these specimens.
Also Featured In
This recommendation also appears in the following guidelines:
Guideline
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach
Year2016
InstitutionWHO