Diagnostic Performance of GeneXpert MTB/RIF for Pulmonary and Extra-Pulmonary Tuberculosis in Morocco.
DOI:
https://doi.org/10.63095/NBSEH.25.602270Keywords:
Tuberculosis, GeneXpert MTB/RIF, Molecular diagnosticsAbstract
This study assesses the performance of the GeneXpert MTB/RIF® test (Cepheid Inc., Sunnyvale, CA, USA) for detecting Mycobacterium tuberculosis and Rifampicin resistance (RR) in Morocco, in comparison with conventional methods such as culture, and contrasts the results with data from other African countries. Conducted over 36 months, the study analysed 4,465 biological samples from patients suspected of tuberculosis at Ibn Sina University Hospital in Rabat between January 2020 and January 2023. The positivity rates for smear microscopy, GeneXpert, and culture were 2.55% (n = 114), 14.49% (n = 647), and 3.27% (n = 146), respectively. Of all samples, 71.41% were negative for both tests, 11.97% were culture-positive but smear-negative, and 10.59% were positive for both. GeneXpert achieved a sensitivity of 92.45%, specificity of 89.06%, negative predictive value of 99.99%, and positive predictive value of 24.48%. Rifampicin resistance was detected in 2.94% (19 samples, including 17 sputum and two cerebrospinal fluid samples). This study emphasizes the value of GeneXpert as a rapid and reliable diagnostic tool for tuberculosis and resistance detection in high-burden contexts, with potential for broad application in developing countries.
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References
World Health Organization, 2023, Increase in the Number of Tuberculosis Cases and Deaths Due to the Disease During the COVID-19 Pandemic. https://www.who.int/en/news/item/27-10-2022-tuberculosis-deaths-and-disease-increase-during-the-covid-19-pandemic
World Health Organization (WHO), 2023, Tuberculosis response recovering from pandemic but accelerated efforts needed to meet new targets. https://www.who.int/news/item/07-11-2023-tuberculosis-response-recovering-from-pandemic-but--accelerated-efforts-needed-to-meet-new-targets
World Health Organization (OMS), 2024, World Tuberculosis Day 2024. https://www.afro.who.int/regional-director/speeches-messages/world-tuberculosis-day-2024
Ministry of Health and Social Protection of Morocco MSPS (2023), Strategic Plan for the Prevention and Control of Tuberculosis in Morocco 2024-2030. https://www.sante.gov.ma/Documents/2023/11/Plan%20strateìgique%20National%20TB%202024-2030.pdf
Purohit, M., Mustafa, T., 2015, Laboratory Diagnosis of Extra-Pulmonary Tuberculosis (EPTB) in Resource-Constrained Setting: State of the Art, Challenges and the Need. Journal of Clinical and Diagnostic Research 9(4). https://doi.org/10.7860/jcdr/2015/12422.5792
Lee, J.Y., 2015, Diagnosis and Treatment of Extrapulmonary Tuberculosis. Tuberculosis and Respiratory Diseases 78(2), 47–55. https://doi.org/10.4046/trd.2015.78.2.47
Parrish, N., Carroll, K. C., 2011, Role of the Clinical Mycobacteriology Laboratory in diagnosis and Management of Tuberculosis in Low-Prevalence Settings. Journal of Clinical Microbiology, 49(3), 772-776. https://doi.org/10.1128/jcm.02451-10
Loïez-Durocher, C., 2000, Resistance of Mycobacterium tuberculosis to Antituberculosis Drugs: Diagnostic Methods. Actualités Bio Cliniques 24(229), 21–29. https://www.jle.com/fr/revues/abc/e-docs/la_resistance_de_mycobacterium_tuberculosis_aux_antituberculeux_methodes_diagnostiques_50301/article.phtml
World Health Organization, 2014, Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children: Policy Update. https://www.who.int/publications/i/item/9789241506335
Guillet-Caruba, C., Martínez, VP., Doucet‐Populaire, F., 2014, New microbiological diagnostic tools for tuberculosis disease. The Journal of Internal Medicine 35(12), 794-800. https://doi.org/10.1016/j.revmed.2014.05.001
Matabane, M. M. Z., Ismail, F., Strydom, K. A., Onwuegbuna, O., Omar, S. V., & Ismail, N., 2015, Performance evaluation of three commercial molecular assays for the detection of Mycobacterium tuberculosis from clinical specimens in a high TB-HIV-burden setting. BMC Infectious Diseases 15(1), 508. https://doi.org/10.1186/s12879-015-1229-9.
Rufai, S.B., Kumar, P., Singh, A., Prajapati, S., Balooni, V., Singh, S., 2014, Comparison of Xpert MTB/RIF with Line Probe Assay for Detection of Rifampin-Monoresistant Mycobacterium tuberculosis. Journal of Clinical Microbiology 52(6), 1846–1852. https://doi.org/10.1128/jcm.03005-13
Rüsch-Gerdes, S., Pfyffer, G.E., Casal, M., Diel, R., Dooley, K., Fissette, K., Gie, R., Hillemann, D., Kam, K.M., Lange, C., Marais, B.J., Martin, C., Niemann, S., Portaels, F., Rodrigues, C., Roring, S., Schönfeld, N., Tortoli, E., van Soolingen, D., 2006, Validation in a Multicenter Laboratory Trial of the BACTEC MGIT 960 Technique for Testing the Susceptibility of Mycobacterium tuberculosis to Classical Second-Line and Newer Antimicrobials. Journal of Clinical Microbiology 44, 688–692. https://doi.org/10.1128/JCM.44.2.688-692.2006
World Health Organization, 1998, Laboratory Services in Tuberculosis Control. Part II. Microscopy. Geneva: World Health Organization. https://www.scirp.org/reference/ReferencesPapers?ReferenceID=1785463
Piatek, A.S., Tyagi, S., Pol, A.C., Cheng, Q., Telenti, A., Musser, J.M., 2000, Genotypic Analysis of Mycobacterium tuberculosis in Two Distinct Populations Using Molecular Beacons: Implications for Rapid Susceptibility Testing. Antimicrobial Agents and Chemotherapy 44(1), 103–110. https://doi.org/10.1128/aac.44.1.103-110.2000
Boehme, C.C., Nabeta, P., Hillemann, D., Nicol, M.P., Shenai, S., Krapp, F., Allen, J., Tahirli, R., Blakemore, R., Rustomjee, R., Milovic, A., Jones, M., O’Brien, S.M., Persing, D.H., Busch, M.P., 2010, Rapid Molecular Detection of Tuberculosis and Rifampin Resistance. The New England Journal of Medicine 363(11), 1005–1015. https://doi.org/10.1056/nejmoa0907847
Kassimi, H., 2014, The Main Factors Promoting Pulmonary Tuberculosis. Doctoral Thesis, Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, p. 130
Nardell, A. E., 2023, Tuberculosis (TB). Merck Sharp & Dohme Manual Professional Edition.https://www.msdmanuals.com/professional/infectious-diseases/mycobacteria/tuberculosis-tb#%C3%89tiology_v1010685_en
Ferroudja Yamouni, M., Bensalem, A., Mekkaoui, N., 2024, Evaluation of GeneXpert® MTB/RIF in the Molecular Diagnosis of Tuberculosis and Rifampicin Resistance in Algeria. Médecine Tropicale et Santé Internationale 4(2). https://doi.org/10.48327/mtsi.v4i2.2024.301
Marouane, C., Bensalem, A., Benmansour, H., 2015, Evaluation of GeneXpert® MTB/RIF in the Molecular Detection of Extrapulmonary Tuberculosis and Rifampicin Resistance. Médecine et Maladies Infectieuses 46, 20–24. https://doi.org/10.1016/j.medmal.2015.10.012
Hefzy, E.M., Elshaer, H.M., Abdelaal, A.M., 2021, Utility of GeneXpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extra-Pulmonary Tuberculosis: A Report from Egypt. Novel Research in Microbiology Journal 5(1), 1146–1161. https://doi.org/10.21608/nrmj.2021.149391
Diallo, K., Ndiaye, M., Sow, A., 2018, Performance of GeneXpert in the Diagnosis of Tuberculosis in a Decentralized Area: Example of Hôpital de la Paix, Ziguinchor, Southern Senegal from 2016 to 2018. International Journal of Open Access Tropical Diseases 1(1). https://doi.org/10.23937/2643-461X/1710059
Massou, F., Lawson-Evi, F., Hounkpe-Domoua, D., 2021, Spot Specimen Testing with GeneXpert MTB/RIF Results Compared to Morning Specimen in a Programmatic Setting in Cotonou, Benin. BMC Infectious Diseases 21(1), 664. https://doi.org/10.1186/s12879-021-06676-6
Munkombwe, P., Mwamba, L., Kasongo, J., 2023, Contribution of GeneXpert MTB/RIF in the Detection of Mycobacterium tuberculosis Infection and Rifampicin Resistance in the General Reference Hospital of Kirungu-Moba, South-East of the Democratic Republic of Congo. Monthly Review Information and Education Scientist. https://www.tanganyikajournalofscience.org/index.php/tjs/article/view/59
Agizew, T., Schumacher, S.G., Moyo, S., Basotli, J., Moroko, M., Ngcobo, N., Mbata, D., Takarinda, K.C., Lopez, J., 2019, Tuberculosis Treatment Outcomes Among People Living with HIV Diagnosed Using Xpert MTB/RIF Versus Sputum-Smear Microscopy in Botswana: A Stepped-Wedge Cluster Randomised Trial. BMC Infectious Diseases 19, 835. https://doi.org/10.1186/s12879-019-4697-5
Sibomana, T., Uwizeyimana, E., Niyonzima, E., 2024, Contribution of GeneXpert MTB/RIF to the Diagnosis of Pleuropulmonary Tuberculosis. Journal of Community Medicine and Public Health Reports. https://doi.org/10.38207/JCMPHR/2024/MAY05090
Motse, F.D.K., Molebatsi, T., Mokhantso, T., 2020, Rifampicin Resistance Among Mycobacterium tuberculosis-Infected Individuals Using GeneXpert MTB/RIF Ultra: A Hospital-Based Study. Tropical Medicine & International Health 26(2), 159–165. https://doi.org/10.1111/tmi.13489
Farra, A., Koyagbele, A., Bessong, P., 2023, The Contribution of the Xpert® MTB/RIF Assay to the Surveillance of Drug-Resistant Tuberculosis in the Central African Republic. Journal of Tuberculosis Research 11(1), 23–32. https://doi.org/10.4236/jtr.2023.111003
Ngakoutou, R., Mahamat, A., Abakar, D., 2023, Performance of GeneXpert in the Diagnosis of Extrapulmonary Tuberculosis at the University Hospital Center (CHU-RN) of N'Djamena in Chad: A Study of 110 Cases. Health Sciences and Disease 24(8), 4676. https://www.hsd-fmsb.org/index.php/hsd/article/view/4676
Elmi, S.Y.K., Mahamoud, H., Aden, A., 2023, Concordance Between Microscopic and Molecular Detection of Mycobacterium tuberculosis in Hospitalized Patients with Suspected Pulmonary Tuberculosis in Peltier General Hospital, Djibouti. International Journal of Life Science Research Archive. https://sciresjournals.com/ijlsra/sites/default/files/IJLSRA-2023-0059.pdf
Condé, M., Camara, M., Barry, A., 2023, Mutation in the Rifampicin Resistance Region in Mycobacterium tuberculosis in Guinea. Microbiology & Infectious Diseases, ISSN 2639-9458. https://www.scivisionpub.com/pdfs/mutation-in-the-rifampicin-resistance-region-in-mycobacterium-tuberculosis-in-guinea-2609.pdf
Rabna, P., Gomes, V., Vassall, A., Martins, T., Macedo, R., 2015, Direct Detection by the Xpert MTB/RIF Assay and Characterization of Multi- and Poly-Drug-Resistant Tuberculosis in Guinea-Bissau, West Africa. Public Library of Science ONE 10(5), e0127536. https://doi.org/10.1371/journal.pone.0127536
Sorsa, A., Alemu, G., Tadesse, M., 2021, Diagnostic Performance of GeneXpert in Tuberculosis–HIV Co–Infected Patients at Asella Teaching and Referral Hospital, Southeastern Ethiopia: A Cross-Sectional Study. Public Library of Science ONE 16(1), e0242205. https://doi.org/10.1371/journal.pone.0242205
Makamure, B., Gomo, E., Mpofu, E., 2017, A Suggested Algorithm for Detection of Multi-Drug-Resistant Tuberculosis in Zimbabwe. Journal of Infection in Developing Countries 11(8), 611–618. https://jidc.org/index.php/journal/article/view/31085822/1734
Abdul, J.B.P.A.A., Moussavou, G., Ibouanga, J., 2022, Resistance Patterns Among Drug-Resistant Tuberculosis Patients and Trends-Over-Time Analysis of National Surveillance Data in Gabon, Central Africa. Infection 51(3), 697–704. https://doi.org/10.1007/s15010-022-01941-5
Ayorinde, A., Darboe, F., Ceesay, F., 2019, PO 8596: Enhancing Laboratory Diagnosis of Mycobacterium tuberculosis in Samples from Children in The Gambia. British Medical Journal Global Health A61.1–A61. https://doi.org/10.1136/bmjgh-2019-edc.160
Boakye-Appiah, F., Asare, S., Osei, F., 2016, High Prevalence of Multidrug-Resistant Tuberculosis Among Patients with Rifampicin Resistance Using GeneXpert Mycobacterium tuberculosis/Rifampicin in Ghana. International Journal of Mycobacteriology 5(2), 226–230. https://doi.org/10.1016/j.ijmyco.2016.02.004
Kouassi N'Guessa, K., Aka, N., Koffi, M., 2018, Multidrug-Resistant Tuberculosis in Côte d'Ivoire from 1995 to 2016: Results of National Surveys. European Journal of Microbiology & Immunology 8(3), 123–130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186018/
Mulengwa, D.L., Dlamini, N., Mamba, P., 2021, Evaluation of the GeneXpert MTB/RIF Assay Performance in Sputum Samples with Various Characteristics from Presumed Pulmonary Tuberculosis Patients in Shiselweni Region, Eswatini. Infectious Diseases 54(3), 170–177. https://doi.org/10.1080/23744235.2021.1992005
Aricha, S.A., Onyango, F., Kiptanui, R., 2019, Comparison of GeneXpert and Line Probe Assay for Detection of Mycobacterium tuberculosis and Rifampicin-Mono Resistance at the National Tuberculosis Reference Laboratory, Kenya. BioMed Central Infectious Diseases 19, 591. https://doi.org/10.1186/s12879-019-4470-9
Rakotoarivelo, R., Razafindralambo, D., Andriamandimby, S., 2018, Evaluation of the Xpert MTB/RIF Assay for the Diagnosis of Smear-Negative Pulmonary and Extrapulmonary Tuberculosis in Madagascar. International Journal of Infectious Diseases 69, 20–25. https://doi.org/10.1016/j.ijid.2018.01.011
Alemayehu, W.A., Chikoko, T., Banda, D., 2019, Comparative Study of OMNIgene® SPUTUM Reagent Versus Cold-Chain for the Transportation of Sputum Samples to GeneXpert® MTB/RIF Testing Sites in Malawi. BioMed Central Infectious Diseases 19, 397. https://doi.org/10.1186/s12879-019-4070-8
Toloba, Y., Traoré, B., Diarra, S., 2017, Contribution of GeneXpert in the Diagnosis of Tuberculosis and Rifampicin Resistance in Mali After 22 Months of Implementation. Journal of Respiratory Diseases 34, A216–A217. https://doi.org/10.1016/j.rmr.2016.10.515
Kakinda, M., Nabeta, P., Kasozi, S., 2022, Comparison of Tests Done, and Tuberculosis Cases Detected by Xpert® MTB/RIF and Xpert® MTB/RIF-Ultra in Uganda. Public Library of Science ONE 17(9), e0275960. https://doi.org/10.1371/journal.pone.0275960
Dagnra, A.Y., Kpatcha, T., Agbeko, K., 2015, Prevalence of Multidrug-Resistant Tuberculosis Cases Among HIV-Positive and HIV-Negative Patients Eligible for Retreatment Regimen in Togo Using GeneXpert MTB/RIF. European Journal of Clinical Microbiology & Infectious Diseases 34, 123–129. https://www.sciencedirect.com/science/article/pii/S2052297515000669
Ilboudo, D., Kaboré, F., Ouédraogo, S., 2015, Molecular Diagnosis of Isoniazid- and Rifampicin-Resistant Mycobacterium tuberculosis Complex in Burkina Faso. Pan African Medical Journal 21, 73. https://doi.org/10.11604/pamj.2015.21.73.5494
Ikuabe, P.O., Agan, T.J., Okokhere, P.O., 2018, Prevalence of Rifampicin Resistance by Automated GeneXpert Rifampicin Assay in Patients with Pulmonary Tuberculosis in Yenagoa, Nigeria. Pan African Medical Journal 29, 204. https://doi.org/10.11604/pamj.2018.29.204.14579
Sindayigaya, A., Niyonzima, E., Mukamuyango, J., 2014, Incremental Yield of the GeneXpert MTB/RIF Assay for the Diagnosis of Pulmonary Tuberculosis in Congregates: Case of Muhanga Prison, South Province, Rwanda. http://hdl.handle.net/123456789/924
Mechal, Y., Belkadi, B., Amadou, H., 2019, Evaluation of GeneXpert MTB/RIF System Performances in the Diagnosis of Extrapulmonary Tuberculosis. BioMed Central Infectious Diseases 19, 636. https://doi.org/10.1186/s12879-019-4687-7
Hassan, H., Traoré, A., Coulibaly, S., 2021, Contribution of the Xpert MTB/RIF Test in the Diagnosis and Treatment of Tuberculosis. Malian Review of Infectious Diseases and Microbiology 16(2), 36–40. https://doi.org/10.53597/remim.v16i2.1868
Halloumi, A., El Malki, L., Ouarzane, M., 2021, Diagnostic Performance of GeneXpert in the Detection of Tuberculosis in the Region of Agadir. Journal of Respiratory Diseases News 13(1), 231. https://doi.org/10.1016/j.rmra.2020.11.519
Ainouss, A., El Idrissi, M., Benhassou, H., 2022, Performance of GeneXpert MTB/RIF in the Diagnosis of Extrapulmonary Tuberculosis in Morocco. Russian Journal of Infection and Immunity 12(1), 78–84. http://dx.doi.org/10.15789/2220-7619-POG-1695
Karimi, H., El Idrissi, M., Benhassou, H., 2018, Performance of GenoType® MTBDRplus Assay in the Diagnosis of Drug-Resistant Tuberculosis in Tangier, Morocco. Journal of Global Antimicrobial Resistance 12, 63–67. https://doi.org/10.1016/j.jgar.2017.09.002
World Health Organization (WHO), 2023, Global Tuberculosis 2023 Report, ISBN 978-92-4-008385-1.https://iris.who.int/bitstream/handle/10665/373828/9789240083851-eng.pdf?sequence=1
United Nations Office for Project Services (UNOPS), 2020, Gender and Tuberculosis, Community, Human Rights and Gender Investment Package. https://stoptb.org/assets/documents/communities/CRG_Investment_Package_Gender_and_TB_06.07.2020_EN.pdf
Ministry of Health and Social Protection of Morocco (MSPS), 2023, Strategic Plan for the Prevention and Control of Tuberculosis in Morocco 2021–2023. https://www.sante.gov.ma/Documents/2022/03/Guide%20Plan%20Strateìgique%20National%20%20(1).pdf
Ministry of Health and Social Protection of Morocco (MSPS), 2023, National Guidelines for Diagnosis and Management of Extrapulmonary Tuberculosis, National Tuberculosis Control Program. https://www.sante.gov.ma/Documents/2024/04/Version%20Finale%20Lignes%20Directrices%20TEP%20PNLAT%20Version%20finale%20%20Août%202023.pdf
Lupande, D., Mukiza, J., Kabeya, F., 2017, GeneXpert MTB/RIF in Pulmonary Tuberculosis Screening at the Provincial General Reference Hospital of Bukavu, Eastern Democratic Republic of Congo: Lessons Drawn After 10 Months of Use. The Pan African Medical Journal 27, 260. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660310/
Guenaoui, K., Benkaddour, R., El Ouardi, A., 2016, Use of GeneXpert Mycobacterium tuberculosis/Rifampicin for Rapid Detection of Rifampicin-Resistant Mycobacterium tuberculosis Strains in Clinically Suspected Multi-Drug Resistant Tuberculosis Cases. Annals of Translational Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876276/
Bunduki, G.K., Mukadi, B.N., Kabundi, L., 2017, Evaluation of the Xpert® MTB/RIF Assay and Microscopy for Diagnosing Pulmonary Tuberculosis in Butembo, Democratic Republic of the Congo. Journal of Advances in Microbiology 7(3), 1–6. https://doi.org/10.9734/JAMB/2017/38667
Meyer, A.J., Kabali, A., Nakiyingi, L., 2017, Sputum Quality and Diagnostic Performance of GeneXpert MTB/RIF Among Smear-Negative Adults with Presumed Tuberculosis in Uganda. Public Library of Science ONE 12(7), e0180572. https://doi.org/10.1371/journal.pone.0180572
Diallo, A.B., Diop, S., Ndiaye, M., 2016, Performance of GeneXpert MTB/RIF® in the Diagnosis of Extrapulmonary Tuberculosis in Dakar: 2010–2015. The Pan African Medical Journal 25, 129. https://doi.org/10.11604/pamj.2016.25.129.10065
Bemba, E.L.P., Mbemba, G., Koukouna, D., 2020, Performance of GeneXpert MTB/RIF in the Diagnosis of Pleural Tuberculosis in Brazzaville: Preliminary Study. Journal of Respiratory Diseases News. https://doi.org/10.1016/j.rmra.2019.11.612
Billardpomares, T., Dupont, C., Martin, A., 2018, Performance of GeneXpert MTB/RIF PCR in the Diagnosis of Extrapulmonary Tuberculosis. Medicine and Infectious Diseases 48(4), S116–S117. https://doi.org/10.1016/j.medmal.2018.04.294
Méchaï, F., Diallo, A., Traoré, M., 2019, Tuberculous Meningitis: Challenges in Diagnosis and Management. Revue Neurologique 175(7–8), 451–457. https://doi.org/10.1016/j.neurol.2019.07.007
Malbruny, B., 2011, Rapid and Efficient Detection of Mycobacterium tuberculosis in Respiratory and Non-Respiratory Samples. International Journal of Tuberculosis and Lung Disease 15(4), 553–555. https://doi.org/10.5588/ijtld.10.0497
Hanane, M., El Idrissi, M., Benhassou, H., 2020, GeneXpert’s Performance in the Diagnosis of Pulmonary and Extrapulmonary Tuberculosis. American Journal of Laboratory Medicine 5(1), 14–17. https://doi.org/10.11648/j.ajlm.20200501.12
Elbrolosy, A.M., Hassan, R., Ahmed, S., 2021, Diagnostic Utility of GeneXpert MTB/RIF Assay Versus Conventional Methods for Diagnosis of Pulmonary and Extrapulmonary Tuberculosis. BioMed Central Microbiology 21, 144. https://doi.org/10.1186/s12866-021-02210-5
Talbi, M., Ben Salem, H., Boukhris, I., 2021, Contribution of Molecular Biology in the Diagnosis of Microscopy-Negative Tuberculosis. Proceedings of the 30th National Congress of the Tunisian Society of Infectious Pathology. www.infectiologie.org.tn
Chiali, A., Benkaddour, R., Boukhelkhal, S., 2017, Contribution of the Polymerase Chain Reaction (PCR) in the Diagnosis of Cutaneous Tuberculosis. Journal of the Faculty of Medicine of Oran (JFMO), No. 4, June 2018, 303.
Hajissa, K., Abas, A., Mohammed, A., 2021, Prevalence of Drug-Resistant Tuberculosis in Sudan: A Systematic Review and Meta-Analysis. Antibiotics 10(8), 932. https://doi.org/10.3390/antibiotics10080932
Xu, G., Li, H., Zhang, Y., 2021, Mechanisms and Detection Methods of Mycobacterium tuberculosis Rifampicin Resistance: The Phenomenon of Drug Resistance is Complex. Tuberculosis 128, 102083. https://doi.org/10.1016/j.tube.2021.102083
Trauer, J. M., & Cheng, A. C., 2016, Multidrug-resistant tuberculosis in Australia and our region. Medical Journal of Australia, 204(7), 251–253. https://doi.org/10.5694/mja16.00012
Kerner, G., Rosain, J., Guérin, A., Al-Khabaz, A., Oleaga-Quintas, C., Rapaport, F., Massaad, M.J., Ding, J.-Y., Khan, T., Al Ali, F., Rahman, M., Deswarte, C., Martínez-Barricarte, R., Geha, R.S., Jeanne-Julien, V., Garcia, D., Chi, C.-Y., Yang, R., Roynard, M., Fleckenstein, B., Rozenberg, F., Boisson-Dupuis, S., Ku, C.-L., Seeleuthner, Y., Béziat, V., Marr, N., Abel, L., Al-Herz, W., Casanova, J.-L., Bustamante, J., 2020, Inherited Human IFN-γ Deficiency Underlies Mycobacterial Disease. The Journal of Clinical Investigation 130(6), 3158–3171. https://doi.org/10.1172/JCI137909
Mollel, E., Mkopi, A., Kidenya, B., Mpagama, S., Kamwela, L., 2019, Effect of Reliance on Xpert MTB/RIF on Time to Treatment and Multidrug-Resistant Tuberculosis Treatment Outcomes in Tanzania: A Retrospective Cohort Study. International Health 11(6), 520–527. https://doi.org/10.1093/inthealth/ihz056
Rahman, S.M.M., Ahmed, T., Hossain, M.A., Islam, M.T., 2022, Performance of WHO-Endorsed Rapid Tests for Detection of Susceptibility to First-Line Drugs in Patients with Pulmonary Tuberculosis in Bangladesh. Diagnostics 12(2), 410. https://doi.org/10.3390/diagnostics12020410
Mahomed, S., Fadeyi, A., Tsekela, R., 2017, Failure of BACTEC™ MGIT 960™ to Detect Mycobacterium tuberculosis Complex within a 42-Day Incubation Period. African Journal of Laboratory Medicine 6(1), 3. https://doi.org/10.4102/ajlm.v6i1.503
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