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All Journal International Journal of Integrated Health Sciences Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Livia Noviani
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Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience

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Validity of Mycobacterium tuberculosis Antigens Cocktail: ESAT-6, CFP-10 and MPT64 in Sputum and Cerebrospinal Fluid for Pulmonary Tuberculosis and Tuberculous Meningitis Diagnosis Dewi Kartika Turbawaty; Nenny Gustiani; Livia Noviani; Ida Parwati
International Journal of Integrated Health Sciences Vol 3, No 2 (2015)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3060.36 KB)

Abstract

Objective: Rapid and accurate TB diagnostics play an important role in detecting the disease. Currently, antigens secreted (ESAT-6, CFP-10 and MPT64) by M. tuberculosis and encoded by genes “Region of Difference” (RD)1, RD2 and RD3 give an opportunity for rapid TB diagnosis. Genomic region RD1-RD3 was deleted in M. bovis BCG strains and absent in mycobacteria other than M. tuberculosis. This property is advantageous because it enable to create a specific diagnostic tools for M. tuberculosis infection. The aim of this study is to determine the validity of TB antigens cocktail (ESAT-6, CFP-10 and MPT64) for pulmonary tuberculosis and TB meningitis diagnosis. Methods: This is a descriptive observational study design. The study was conducted at the Clinical Pathology Laboratory of Dr. Hasan Sadikin General Hospital during September 2012 until March 2013 for the pulmonary tuberculosis study and from January 2014 to May 2014 for the TB meningitis study. The TB antigen cocktail rapid immunochromatography (ICT) test was done on all of the samples. The sputum and CSF were cultured as gold standards. Results: There were 149 pulmonary and 41 TB meningitis subjects. The sensitivity of TB antigens cocktail rapid ICT for diagnosing pulmonary tuberculosis was 95.7% with a specificity of 87.2%. Of 41 TB meningitis subjects, based on Marais criteria, there were 6 (16%) subjects with a definite TB meningitis, 26 (63%) subjects with probable TB meningitis and 9 (21%) subjects with possible TB meningitis. The sensitivity and specificity of TB antigens cocktail rapid ICT for TB meningitis diagnosis were 83.3% and 68.5% respectively. Conclusions: In this study, rapid ICT TB antigens cocktail (ESAT-6, CFP-10 and MPT64) from sputum sample has good validity for diagnosing a pulmonary tuberculosis, and from CSF sample has moderate validity to diagnose TB meningitis. Keywords: M. tuberculosis culture, pulmonary TB, TB meningitis, TB antigens cocktail (ESAT-6, CFP-10 and MPT64) rapid ICT DOI: 10.15850/ijihs.v3n2.585
KESAHIHAN PEMERIKSAAN COMPLEX SPECIFIC COCKTAIL ANTIGEN TB (ESAT-6, CFP-10, MPT-64) METODE CEPAT IMMUNOCHROMATOGRAPHY PADA CAIRAN SEREBROSPINAL PASIEN MENINGITIS TUBERKULOSIS {Validity of Rapid Immunochromatography Complex Specific Cocktail Antigen TB (Esat-6, Cfp-10, Mpt-64) Using Cerebrospinal Fluid of Tuberculous Meningitis Patient} Livia Noviani; Ida Parwati; Ganiem AR; Turbawati DK
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 22, No 1 (2015)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v22i1.1222

Abstract

The early diagnosis of definite tuberculous meningitis (TBM) is very important in reducing its mortality. The current gold standard ofTBM relies on the isolation of M. tuberculosis from cerebrospinal fluid (CSF) either with direct staining or M. tuberculosis culture, but theseexamination have a low sensitivity due to the pausibasilary condition. Recently there is an assay using rapid Immunochromatography(ICT) cocktail antigen TB in CSF to diagnose TBM. This method can detect ESAT-6, CFP-10 and MPT-64 antigen as an important virulencefactor for the spreading of bacteria to extra pulmonary which is secreted by M. tuberculosis in CSF from TBM patient. The aim of thisstudy was to know the validity of rapid ICT cocktail antigen TB using CSF against MODS culture and acid-fast bacili as a gold standardto diagnose TBM by analyzing. This study iscarried out by a descriptive observational study using cross sectional study design. Thesubjects are patients who were diagnosed as suspected TBM based on Marais criteria and were obtained from the Department of NeurologyHospital Dr. Hasan Sadikin. The examination was done at the Clinical Microbiology Department of Clinical Pathology Dr. Hasan Sadikinhospital since January 2014 until May 2014. A total of 41 subjects which consisted of six (6) subjects with a definite diagnosis of TBM,26 with probable TBM and nine (9) with possible TBM were enrolled in this study. The result of this assay againts acid-fast bacili has the100% sensitivity, 64.1% specificity, 12.5% PPV, 100% NPV, LR(+) 2.78, LR(–)0 and 65.8% accuracy. The result of this assay againtsM. tuberculosis culture has the 83.3% sensitivity, 68.5% specificity, PPV 31.2%, NPV 96%, LR(+) 2.65, LR(–)0.24, accuracy 70.7% andprevalence ratio 7.8. Based on this study, it can be concluded that the validity of this assay againts acid-fast bacili has a high sensitivity,moderate specificity, low PPV, high NPV and moderate accuracy. The result of this assay againts M. tuberculosis culture has a moderatesensitivity and specificity, low PPV, high NPV and moderate accuracy.
Co-Authors Dewi Kartika Turbawaty Ganiem AR Ida Parwati Nenny Gustiani Turbawati DK