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Cohort study
A single Xpert MTB/RIF test of sputum for diagnosis of tuberculosis and multidrug resistance shows high sensitivity and specificity and reduces diagnosis and treatment delays
  1. Annelies Van Rie
  1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Annelies Van Rie
    Department of Epidemiology, University of North Carolina at Chapel Hill, 2104F McGavran Greenberg Hall, Chapel Hill, NC 27599, USA; vanrie{at}email.unc.edu

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In 2009, there were more than 9 million new cases of tuberculosis, but only 63% were diagnosed. The situation for multidrug-resistant tuberculosis (MDR-TB) was even more dismal, with less than 12% of the estimated 250 000 cases diagnosed.1 The most important cause for the diagnostic gap was the absence of a rapid and sensitive test. Smear microscopy, the most widespread first-line diagnostic, is cheap and simple but has poor sensitivity and cannot detect resistance. Culture is highly sensitive and can identify drug resistance, but it requires a sophisticated laboratory infrastructure and is slow. Following a large evaluation study,2 the WHO recommended Xpert MTB/RIF (Xpert), a highly automated real-time PCR assay, as the initial diagnostic test for people suspected …

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