GeneExpert MTB/RIF test, 兩小時內知道MTB和rifampicin resistance
說是rapid TB diagnosis in low-income countries
台灣也很需要啊!!
優點是人員不需要太多training, 不太會有染污的問題
一般檢驗室就可以做
缺點是貴，一個cartrige大概是600元新台幣，一台是80萬台幣
但大量使用後可望降價
不然等一個TB culture要等6-8星期
病人就是燒給你看
還沒確診給他吃TB藥，副作用出來你就嗝屁了
這種19世紀的檢驗方法不符合21世紀病人和社會的期待……
我不想被關10個月啊!!
Rapid Tuberculosis Diagnosis in Low-Income Countries
An automated molecular test for Mycobacterium tuberculosis and rifampin resistance demonstrated excellent sensitivity using untreated sputum from patients with suspected pulmonary infection.
The acid-fast bacillus smear has been critical in the rapid diagnosis of pulmonary tuberculosis (TB) in resource-limited countries. However, the sensitivity of this technique is limited, and more-useful tools such as molecular tests have not been an option due to the cost of training and equipment.
In a partially industry-funded, multinational trial involving 1730 patients with suspected pulmonary TB, researchers examined the performance of an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF). The test involves only one manual step: adding a bactericidal buffer to sputum before transferring a defined volume of sputum to a cartridge. The cartridge is inserted in the test apparatus, and results are available within 2 hours.
On initial screening, the Xpert MTB/RIF test identified 551 of 561 patients with smear- and culture-positive TB (98.2%) and 124 of 171 patients with smear-negative, culture-positive disease (72.5%). In this latter group, sensitivity increased to 90.2% when the test was done three times. The estimated specificity was 99.2% for a single test. In addition, the test correctly identified 200 of 205 patients with rifampin-resistant TB strains (97.6%).
Comment: The Xpert MTB/RIF test proved useful as a point-of-treatment tool in the high-burden countries (Peru, Azerbaijan, South Africa, and India) in this investigation. But although the assay is accurate, rapid, and simple to perform with minimal training, the necessary equipment and supplies are costly. As noted by editorialists, novel collaborations involving government, product developers, and private industry could greatly diminish the global burden of TB.
— Larry M. Baddour, MD
Published in Journal Watch Infectious Diseases September 1, 2010
Citation(s):
Boehme CC et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010 Sep 1; [e-pub ahead of print]. (http://www.nejm.org/doi/full/10.1056/NEJMoa0907847)
https://docs.google.com/fileview?id=0B278nGJMQBk7NDNiMTM3ZTItOGQ3ZS00ZDk2LTg4ZjktMjJjZDI2NDg3Mzlk&hl=zh_TW
Small PM and Pai M. Tuberculosis diagnosis — Time for a game change. N Engl J Med 2010 Sep 1; [e-pub ahead of print]. (http://www.nejm.org/doi/full//10.1056/NEJMoa1008496)
https://docs.google.com/fileview?id=0B278nGJMQBk7NjcxMGYxY2MtMDE3OS00OWZjLWFjM2YtOGMyYWI5MTQwMTM4&hl=zh_TW
台灣也很需要啊!!
優點是人員不需要太多training, 不太會有染污的問題
一般檢驗室就可以做
缺點是貴，一個cartrige大概是600元新台幣，一台是80萬台幣
但大量使用後可望降價
不然等一個TB culture要等6-8星期
病人就是燒給你看
還沒確診給他吃TB藥，副作用出來你就嗝屁了
這種19世紀的檢驗方法不符合21世紀病人和社會的期待……
我不想被關10個月啊!!
Rapid Tuberculosis Diagnosis in Low-Income Countries
An automated molecular test for Mycobacterium tuberculosis and rifampin resistance demonstrated excellent sensitivity using untreated sputum from patients with suspected pulmonary infection.
The acid-fast bacillus smear has been critical in the rapid diagnosis of pulmonary tuberculosis (TB) in resource-limited countries. However, the sensitivity of this technique is limited, and more-useful tools such as molecular tests have not been an option due to the cost of training and equipment.
In a partially industry-funded, multinational trial involving 1730 patients with suspected pulmonary TB, researchers examined the performance of an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF). The test involves only one manual step: adding a bactericidal buffer to sputum before transferring a defined volume of sputum to a cartridge. The cartridge is inserted in the test apparatus, and results are available within 2 hours.
On initial screening, the Xpert MTB/RIF test identified 551 of 561 patients with smear- and culture-positive TB (98.2%) and 124 of 171 patients with smear-negative, culture-positive disease (72.5%). In this latter group, sensitivity increased to 90.2% when the test was done three times. The estimated specificity was 99.2% for a single test. In addition, the test correctly identified 200 of 205 patients with rifampin-resistant TB strains (97.6%).
Comment: The Xpert MTB/RIF test proved useful as a point-of-treatment tool in the high-burden countries (Peru, Azerbaijan, South Africa, and India) in this investigation. But although the assay is accurate, rapid, and simple to perform with minimal training, the necessary equipment and supplies are costly. As noted by editorialists, novel collaborations involving government, product developers, and private industry could greatly diminish the global burden of TB.
— Larry M. Baddour, MD
Published in Journal Watch Infectious Diseases September 1, 2010
Citation(s):
Boehme CC et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010 Sep 1; [e-pub ahead of print]. (http://www.nejm.org/doi/full/10.1056/NEJMoa0907847)
https://docs.google.com/fileview?id=0B278nGJMQBk7NDNiMTM3ZTItOGQ3ZS00ZDk2LTg4ZjktMjJjZDI2NDg3Mzlk&hl=zh_TW
Small PM and Pai M. Tuberculosis diagnosis — Time for a game change. N Engl J Med 2010 Sep 1; [e-pub ahead of print]. (http://www.nejm.org/doi/full//10.1056/NEJMoa1008496)
https://docs.google.com/fileview?id=0B278nGJMQBk7NjcxMGYxY2MtMDE3OS00OWZjLWFjM2YtOGMyYWI5MTQwMTM4&hl=zh_TW
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