Xpert Ultra important tool for rapid diagnosis of spinal tuberculosis

A recent study revealed promising outcomes for Xpert Ultra, a non-invasive approach in enhancing spinal tuberculosis (STB) diagnosis. The key findings were published in Open Forum Infectious Diseases.

The study was conducted from November 2020 to December 2021 and focused on evaluating the efficacy of Xpert MTB/RIF Ultra, comparing it with traditional Mycobacterium tuberculosis (Mtb) culture and histopathology. 

The study was aimed to refining diagnostic procedures of STB and showed compelling results. Xpert Ultra demonstrated a remarkable sensitivity of 94.7% and an impressive specificity of 100%, outperforming the conventional Mtb culture and histopathology as the reference standard. This breakthrough is poised to transform the landscape of STB diagnosis, when considering the limitations associated with current methods, predominantly reliant on open surgeries for specimen collection.

The prospective diagnostic accuracy study included 31 adult patients exhibiting signs and symptoms of STB. Xpert Ultra's diagnostic prowess remained consistent across both open and CT-guided biopsy samples, improving the sensitivity and specificity to 100% for open biopsies and 89% and 100%, respectively, for CT-guided ones. However, Mtb culture exhibited a notable specificity gap for CT-guided biopsies, hovering at 43%.

Also, the study found that HIV-1 co-infection did not influence the accuracy of Mtb abundance measures by Xpert Ultra or culture. Xpert Ultra surpassed traditional culture methods for STB diagnosis even in patients concurrently undergoing treatment for pulmonary TB.

The study's conclusion brings out the ability of Xpert Ultra to detect more STB cases than conventional culture methods, particularly in CT-guided biopsy samples, and maintaining consistent sensitivity for open biopsies, Xpert Ultra emerges as a crucial tool for swift and accurate diagnosis, especially when open surgery is impractical or when simultaneous treatment for pulmonary TB is underway.

Source:

Waters, R., Laubscher, M., Dunn, R. N., Adikary, N., Coussens, A. K., & Held, M. (2023). Higher sensitivity of Xpert MTB/RIF Ultra over TB culture for the diagnosis of spinal tuberculosis using open or CT-guided biopsies. In Open Forum Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/ofid/ofad621