Perbandingan Positivitas Metode MODS, Pewarnaan ZN, dan GeneXpert untuk Mendeteksi M. tuberculosis pada Pasien Meningitis TB
Abstract
Salah satu permasalahan dalam diagnosis meningitis tuberkulosis (TB) adalah rendahnya positivitas metode yang digunakan. Berbagai metode telah dikembangkan, mulai dari metode kultur MODS (microscopic observation drug susceptibility), pewarnaan Ziehl-Neelsen (ZN), hingga GeneXpert. Penelitian ini dilakukan untuk menentukan metode diagnostik terbaik mendeteksi M. tuberculosis berdasar atas nilai positivitasnya. Penelitian ini merupakan observasional analitik dengan rancangan potong lintang. Data berasal dari penelitian kohort dan ReDEFINe meningitis TB di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Data diambil dari case report form pasien dengan diagnosis meningitis TB pada periode Juli 2014–Juni 2016. Kriteria inklusi penelitian ini adalah usia ≥18 tahun dan memiliki hasil pemeriksaan MODS, pewarnaan ZN, dan GeneXpert. Analisis data menggunakan Uji Cochran’s Q dan uji lanjut dengan Uji McNemar. Sebanyak 135 subjek penelitian memenuhi kriteria inklusi dan didapatkan positivitas deteksi M. tuberculosis menggunakan MODS, pewarnaan ZN, dan GeneXpert berturut-turut adalah 46,7%; 20,0%; dan 37,8%. Nilai positivitas antara ketiga metode tersebut secara statistik berbeda bermakna dengan nilai p<0,05. Sensitivitas dan spesifisitas GeneXpert dibanding dengan MODS berturut-turut mencapai 68,3% dan 88,9%, sedangkan sensitivitas pewarnaan ZN sebesar 34,9% dan spesifisitas 93.1%. Berdasar atas nilai positivitas dan sensitivitas, hasil penelitian ini menunjukkan bahwa metode MODS masih merupakan metode diagnostik terbaik untuk meningitis TB.
Kata kunci: Diagnosis, GeneXpert, meningitis tuberkulosis, MODS, pewarnaan Ziehl- Neelsen
Comparison of Positivity Rate of MODS, Ziehl-Neelsen Staining, and GeneXpert Methods in M. tuberculosis Detection among Tuberculous Meningitis Patients
One of the problems in the diagnosis of tuberculous meningitis (TBM) is the low positivity rate of the diagnostic methods. Various methods have been developed, starting from culture MODS (microscopic observation drug susceptibility) to Ziehl-Neelsen (ZN) staining and to GeneXpert. This study was conducted to determine the best diagnostic method to detect M. tuberculosis based on its positivity rate. This cross-sectional analytic observational study was conducted on TBM cohort of the ReDEFINe study in Dr. Hasan Sadikin General Hospital. Data were collected from the case reports of TBM inpatients during the period of July 2014–June 2016. Patients ≥18 years who had complete result from MODS, ZN staining, and GeneXpert were included. Data were analyzed using Cochran’s Q test and post-hoc analysis using McNemar test. In total, 135 subjects were included in this study. The positivity rates of M. tuberculosis detection using MODS, ZN staining, and GeneXpert were 46.7%, 20.0%, and 37.8%, respectively. The positivity rate differences among the three diagnostic methods were statistically significant with a p-value of <0.05. The sensitivity and specificity of GeneXpert compared to those of MODS were 68.3% and 88.9%,respectively. Meanwhile the sensitivity and specificity of ZN staining were 34.9% and 93.1%, respectively. Based on the positivity rate and sensitivity, the results of this study indicates that the MODS method is still the best diagnostic method for TB meningitis.
Key words: Diagnosis, GeneXpert, MODS, tuberculous meningitis, ziehl-neelsen Staining
Keywords
Full Text:
PDFReferences
WHO. Global Tuberculosis Report 2015. Geneva: WHO; 2015.
Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2):47–55.
Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008;21(2):243–61.
Pasco PM. Diagnostic features of tuberculous meningitis: a cross-sectional study. BMC Res Notes. 2012;5(1):49.
Murthy JMK. Tuberculous meningitis: the challenges. Neurol India. 2010;58(5):716.
Marais S, Wilkinson RJ. The diagnosis and medical management of tuberculous meningitis in adults. S Afr Med J. 2014; 104(12):895.
Caws M, Ha DTM, Torok E, Campbell J, Thu DDA, Chau TTH, dkk. Evaluation of the MODS culture technique for the diagnosis of tuberculous meningitis. PLoS One. 2007;2(11):1–11.
Zhang L, Feng G, Zhao G. Tuberculous meningitis in Asia. Neurol Asia. 2015;20(1):1–6.
Nhu NTQ, Heemskerk D, Thu DDA, Chau TTH, Mai NTH, Nghia HDT, dkk. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis. J Clin Microbiol. 2014;52(1):226–33.
Lawn S, Nicol M. Xpert® MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance. Future Microbiol. 2011;6(9):1067–82.
Carrol KC, Hobden JA, Miller S, Morse SA, Mietzner TA, Detrick B, dkk. Jawetz melnick & adelbergs medical microbiology. Edisi ke-27. New York: McGraw-Hill Education; 2015. hlm. 309-17.
WHO. Xpert MTB/RIF implementation manual technical and operational “how-to”: practical considerations. Geneva: WHO; 2014.
Christensen A-SH, Andersen ÅB, Thomsen VØ, Andersen PH, Johansen IS. Tuberculous meningitis in Denmark: a review of 50 cases. BMC Infect Dis. 2011;11(1):1–6.
Brancusi F, Farrar J, Heemskerk D. Tuberculous meningitis in adults: a review of a decade of developments focusing on prognostic factors for outcome. Future Microbiol. 2012;7(9):1101–16.
Mendoza MT, Cajucom MAM, Itable JR, Zamora RP. Evaluation of the usefulness of the MODS assay for the detection of TB and MDR-TB among PTB suspects in the Philippines. Clin Microbiol. 2015;4(4):1–6.
Aminzadeh Z, Fallah F, Manafian B, Baghaei P. Evaluation of MODS culture in the diagnosis of pulmonary tuberculosis. African J Microbiol Res. 2012;6(2):288–91.
Chen P, Shi M, Feng G-D, Liu J-Y, Wang B-J, Shi X-D, dkk. A highly efficient Ziehl-Neelsen stain: identifying de novo intracellular Mycobacterium tuberculosis and improving detection of extracellular M. tuberculosis in cerebrospinal fluid. J Clin Microbiol. 2012;50(4):1166–70.
Patel VB, Theron G, Lenders L, Matinyena B, Connolly C, Singh R, dkk. Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous meningitis in a high burden setting: a prospective study. PLoS Med. 2013;10(10):1–13.
Bahr NC, Tugume L, Rajasingham R, Kiggundu R, Williams DA, Morawski B, dkk. Improved diagnostic sensitivity for tuberculous meningitis with Xpert MTB/RIF of centrifuged CSF. Int J Tuberc Lung Dis. 2015;19(10):1209–15.
Feng GD, Shi M, Ma L, Chen P, Wang BJ, Zhang M, dkk. Diagnostic accuracy of intracellular Mycobacterium tuberculosis detection for tuberculous meningitis. Am J Respir Crit Care Med. 2014;189(4):475–81.
DOI: https://doi.org/10.15395/mkb.v50n4.1267
Article Metrics
Abstract view : 2209 timesPDF - 1691 times
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Statistics