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Diagnostic accuracy of nucleic acid amplification tests (NAATs) in urine for genitourinary tuberculosis: a systematic review and meta-analysis

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dc.contributor.author Altez-Fernandez, Carlos
dc.contributor.author Ortiz, Victor
dc.contributor.author Mirzazadeh, Majid
dc.contributor.author Zegarra, Luis
dc.contributor.author Seas Ramos, Carlos Rafael
dc.contributor.author Ugarte Gil, Cesar Augusto
dc.date.accessioned 2019-01-25T15:18:33Z
dc.date.available 2019-01-25T15:18:33Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4636
dc.description.abstract BACKGROUND: Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis. Diagnosis is difficult because of unspecific clinical manifestations and low accuracy of conventional tests. Unfortunately, the delayed diagnosis impacts the urinary tract severely. Nucleic acid amplification tests yield fast results, and among these, new technologies can also detect drug resistance. There is lack of consensus regarding the use of these tests in genitourinary tuberculosis; we therefore aimed to assess the accuracy of nucleic acid amplification tests in the diagnosis of genitourinary tuberculosis and to evaluate the heterogeneity between studies. METHODS: We did a systematic review and meta-analysis of research articles comparing the accuracy of a reference standard and a nucleic acid amplification test for diagnosis of urinary tract tuberculosis. We searched Medline, EMBASE, Web of Science, LILACS, Cochrane Library, and Scopus for articles published between Jan 1, 1990, and Apr 14, 2016. Two investigators identified eligible articles and extracted data for individual study sites. We analyzed data in groups with the same index test. Then, we generated pooled summary estimates (95% CIs) for sensitivity and specificity by use of random-effects meta-analysis when studies were not heterogeneous. RESULTS: We identified eleven relevant studies from ten articles, giving information on PCR, LCR and Xpert MTB/RIF tests. All PCR studies were "in-house" tests, with different gene targets and had several quality concerns therefore we did not proceed with a pooled analysis. Only one study used LCR. Xpert studies were of good quality and not heterogeneous, pooled sensitivity was 0.87 (0.66-0.96) and specificity was 0.91 (0.84-0.95). CONCLUSION: PCR studies were highly heterogeneous. Among Xpert MTB/RIF studies, specificity was favorable with an acceptable confidence interval, however new studies can update meta-analysis and get more precise estimates. Further high-quality studies are urgently needed to improve diagnosis of genitourinary tuberculosis. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Infectious Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Sensitivity and Specificity en_US
dc.subject Genitourinary tuberculosis en_US
dc.subject Nucleic acid amplification test en_US
dc.subject Systematic review en_US
dc.subject Mycobacterium tuberculosis/genetics/pathogenicity en_US
dc.subject Nucleic Acid Amplification Techniques/methods en_US
dc.subject Polymerase Chain Reaction/methods en_US
dc.subject Tuberculosis, Urogenital/diagnosis/urine en_US
dc.title Diagnostic accuracy of nucleic acid amplification tests (NAATs) in urine for genitourinary tuberculosis: a systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12879-017-2476-8
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1471-2334


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