{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:46:20Z","timestamp":1792593980940,"version":"4.5.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T00:00:00Z","timestamp":1577664000000},"content-version":"vor","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In most developing countries, smear-negative pulmonary TB (SNPT) often gets missed from the diagnosis of consideration, though it accounts 30\u201365% of total PTB cases, due to deficient or inaccessible molecular diagnostic modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cross-sectional study enrolled 360 patients with clinical-radiological suspicion of SNPT in Tribhuvan University Teaching Hospital (TUTH). The patient selection was done as per the algorithm of Nepal\u2019s National Tuberculosis Program (NTP) for Xpert MTB\/RIF testing. Participants\u2019 demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB\/RIF test according to the manufacturer\u2019s protocol. The same samples were stained using the Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with a Line Probe Assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3(0.8%) of them were rifampicin resistance. The infection was higher in males, i.e. 60(25.3%) compared to female 25(20.3%). The age group, &gt;\u200945(nearly 33%) with median age 42\u2009\u00b1\u200921.5, were prone to the infection. During the study period, 4.6% (515\/11048) sputum samples were reported as smear-positive in TUTH. Consequently, with Xpert MTB\/RIF assay, the additional case 16.5% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200985\/515) from smear-negative presumptive TB cases were detected. Among the most occurring clinical presentations, cough and chest pain were positively associated with SNPT. While upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were the most peculiar radiological impression noted in PTB patient. 94 multi-drug resistant(MDR) suspected cases were enrolled; of total suspects, 29(30.8%) samples were rifampicin sensitive, 1(1.06%) indeterminate, 3(3.19%) rifampicin-resistant while remaining of them were negative. 2(2.2%) MDR cases were recovered from the patient with a previous history of ATT, of total 89 previously treated cases enrolled However, a single rifampicin-resistant from the new suspects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With an application of the assay, the additional cases, missed with smear microscopy, could be sought and exact incidence of the diseases could be revealed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-019-4728-2","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T15:02:17Z","timestamp":1577718137000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Diagnosis of tuberculosis from smear-negative presumptive TB cases using Xpert MTB\/Rif assay: a cross-sectional study from Nepal"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1525-8130","authenticated-orcid":false,"given":"Priyatam","family":"Khadka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Januka","family":"Thapaliya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh Bahadur","family":"Basnet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokarna Raj","family":"Ghimire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti","family":"Amatya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basista Parsad","family":"Rijal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,30]]},"reference":[{"key":"4728_CR1","unstructured":"World Health Organization. Global Tuberculosis Report 2017: Leave no one behind - Unite to end TB [Internet] 2017. 146 p. Available from: http:\/\/www.who.int\/tb\/publications\/global_report\/gtbr2017_main_text.pdf?ua=1"},{"key":"4728_CR2","doi-asserted-by":"crossref","unstructured":"Pandey P, Pant ND, Rijal KR, Shrestha B, Kattel S, Banjara MR, et al. Diagnostic Accuracy of GeneXpert MTB \/ RIF Assay in Comparison to Conventional Drug Susceptibility Testing Method for the Diagnosis of Multidrug-Resistant Tuberculosis 2017;8\u201313.","DOI":"10.1371\/journal.pone.0169798"},{"key":"4728_CR3","unstructured":"World Health Organization. Policy statement: automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: In: MTB\/RIF, WHO Policy Xpert,Xpert MTB\/RIF system WHO\/HTM\/TB\/20114 Geneva; 2011."},{"key":"4728_CR4","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1155\/2015\/102430","volume":"2015","author":"P Shrestha","year":"2015","unstructured":"Shrestha P, Arjyal A, Caws M, Prajapati KG, Karkey A, Dongol S, et al. The application of GeneXpert MTB \/ RIF for smear-negative TB diagnosis as a fee-paying Service at a South Asian General Hospital. Tuberc Res Treat. 2015;2015:6 Available from: https:\/\/doi.org\/10.1155\/2015\/102430.","journal-title":"Tuberc Res Treat"},{"key":"4728_CR5","volume-title":"Annual report 2016","author":"NTP Nepal","year":"2016","unstructured":"Nepal NTP. Annual report 2016. Thimi: Government of Nepal Ministry of Health Department of Health Services National Tuberculosis Center; 2016. 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Permission from NTP authorities was obtained before the study was conducted. A written informed consent was taken from all patients or from their parents (for the patient aged <\u200916\u2009year-old) before participating in the study. Data regarding personal information and infectious disease were coded and kept confidential.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1090"}}