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. 2019 Nov 15;5(4):00008-2019.
doi: 10.1183/23120541.00008-2019. eCollection 2019 Oct.

EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy

Prashant N Chhajed  1   2 , Preyas J Vaidya  1   2 , Neha P Mandovra  1   2 , Vinod B Chavhan  1   2 , Tejashree T Lele  1   2 , Rekha Nair  3 , Jörg D Leuppi  4 , Avinandan Saha  1
Affiliations

EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy

Prashant N Chhajed et al. ERJ Open Res. .

Abstract

This study aimed to examine the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the rapid diagnosis of mediastinal tuberculous lymphadenitis and drug-resistant mediastinal tuberculous lymphadenitis. A diagnosis of TB was confirmed by a positive Xpert MTB/RIF test or Mycobacterium tuberculosis culture. Rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB) was diagnosed upon the detection of rifampicin resistance by Xpert MTB/RIF or resistance to rifampicin and isoniazid by phenotypic drug susceptibility testing (DST). Xpert MTB/RIF was positive in 43 of 56 patients (77%) and TB culture was positive in 31 of 56 patients (55%). Of these 56 patients, 25 (45%) were Xpert MTB/RIF positive and TB culture negative, 13 (23%) were Xpert MTB/RIF negative and TB culture positive, and 18 (32%) were Xpert MTB/RIF positive and TB culture positive. 11 patients (20%) had drug-resistant TB: seven with RR/MDR-TB, one with pre-extensively drug-resistant (XDR) TB, two with XDR-TB and one with isoniazid mono-resistance. An Xpert MTB/RIF assay carried out on EBUS-TBNA specimens provides rapid diagnosis of TB. Xpert MTB/RIF testing appears to have additional and more rapid sensitivity compared with culture alone. Culture-based DST provides an additional exclusive yield and the full resistance profile in addition to or instead of rifampicin resistance.

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Conflict of interest statement

Conflict of interest: P.N. Chhajed has nothing to disclose. Conflict of interest: P.J. Vaidya has nothing to disclose. Conflict of interest: N.P. Mandovra has nothing to disclose. Conflict of interest: V.B. Chavhan has nothing to disclose. Conflict of interest: T.T. Lele has nothing to disclose. Conflict of interest: R. Nair has nothing to disclose. Conflict of interest: J.D. Leuppi has nothing to disclose. Conflict of interest: A. Saha has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Xpert MTB/RIF assay, tuberculosis (TB) culture and drug susceptibility testing (DST) in the study population. MTB: Mycobacterium tuberculosis; RIF: rifampicin; XDR: extensively drug resistant; MDR: multidrug resistant.
See this image and copyright information in PMC

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