{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:33:53Z","timestamp":1786649633855,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Tuberculosis (TB), caused by\n                      <jats:italic toggle=\"yes\">Mycobacterium tuberculosis<\/jats:italic>\n                      complex, results in approximately 1.5 million annual deaths globally. Diagnosing extrapulmonary TB (EPTB) remains challenging due to the invasive nature of sample collection and limitations in conventional diagnostic sensitivity. This study evaluates the diagnostic performance of Xpert\n                      <jats:sup>\u00ae<\/jats:sup>\n                      <jats:italic toggle=\"yes\">Mycobacterium tuberculosis<\/jats:italic>\n                      \/Rifampicin (MTB\/RIF), a nucleic acid amplification test, against direct microscopy for EPTB specimens. In addition, we compare the detection of first-line anti-tubercular drug resistance between Xpert\n                      <jats:sup>\u00ae<\/jats:sup>\n                      MTB\/RIF and the MTB-DR plus line probe assay.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      From January 2022, to April 2023, 2839 clinically suspected EPTB specimens were collected from patients referred to tertiary care hospitals in Gorakhpur, India. Specimens included lymph node aspirates, pleural fluid, cerebrospinal fluid, and tissue biopsies, processed according to the Indian National Tuberculosis Elimination Program protocols. Diagnostic evaluations employed microscopy (acid-fast bacilli staining), Xpert\n                      <jats:sup>\u00ae<\/jats:sup>\n                      MTB\/RIF, and MTB-DR\n                      <jats:italic toggle=\"yes\">plus<\/jats:italic>\n                      assays.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 2839 specimens, Xpert\n                      <jats:sup>\u00ae<\/jats:sup>\n                      MTB\/RIF detected\n                      <jats:italic toggle=\"yes\">M. tuberculosis<\/jats:italic>\n                      in 339 cases (11.9%), significantly outperforming microscopy (183 cases, 6.4%). The highest positivity rates occurred in tissue biopsies and lymph node aspirates (29%), while genitourinary TB was least frequent. Rifampicin resistance was identified in 14 cases (4.13%), all confirmed as multidrug-resistant TB (MDR-TB) by MTB-DR plus.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      Xpert\n                      <jats:sup>\u00ae<\/jats:sup>\n                      MTB\/RIF demonstrated superior sensitivity over microscopy, supporting its utility for EPTB diagnosis in low-resource settings. The high MDR-TB prevalence (4.13%) underscores the need for rapid molecular diagnostics to guide treatment. However, global EPTB burden estimates remain inconsistent, necessitating standardized surveillance and diagnostic protocols to improve detection accuracy and inform public health strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijmy.ijmy_17_25","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T15:00:22Z","timestamp":1750431622000},"page":"110-116","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Diagnostic Modalities for Detecting Extrapulmonary Tuberculosis and Resistance Patterns of Rifampicin and Isoniazid at a Referral Hospital: A Retro Prospective Study"],"prefix":"10.4103","volume":"14","author":[{"given":"Ankur","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3179-7003","authenticated-orcid":false,"given":"Amresh Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Gaur","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini Kumar","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj Kishore","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"100377","DOI":"10.1016\/j.jctube.2023.100377","article-title":"Epidemiology and factors associated with extra-pulmonary tuberculosis in a low-prevalence area","volume":"32","author":"Rolo","year":"2023","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"R4-20260422","doi-asserted-by":"crossref","first-page":"912","DOI":"10.4103\/mjdrdypu.mjdrdypu_678_20","article-title":"Role of cartridge-based nucleic acid amplification test in diagnosing extrapulmonary tuberculosis","volume":"15","author":"Kannuri","year":"2022","journal-title":"Med J DY Patil Vidyapeeth"},{"key":"R6-20260422","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1080\/17476348.2021.1927718","article-title":"Extrapulmonary tuberculosis","volume":"15","author":"Sharma","year":"2021","journal-title":"Expert Rev Respir Med"},{"key":"R7-20260422","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.ijtb.2018.06.011","article-title":"Role of line probe assay in detection of extra-pulmonary tuberculosis: Experience from a tertiary care hospital in Western Maharashtra","volume":"66","author":"Ghanekar","year":"2019","journal-title":"Indian J Tuberc"},{"key":"R10-20260422","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ijmmb.2022.10.008","article-title":"National TB elimination programme \u2013 What has changed","volume":"42","author":"Khanna","year":"2023","journal-title":"Indian J Med Microbiol"},{"key":"R11-20260422","first-page":"2122","article-title":"Clinical profile of pulmonary and extrapulmonary cases of tuberculosis at a tertiary care center","volume":"13","author":"Patel","year":"2023","journal-title":"Nat J Physiol Pharm Pharmacol"},{"key":"R12-20260422","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4103\/jdmimsu.jdmimsu_77_17","article-title":"Role of adenosine deaminase in pleural fluid in tubercular pleural effusion","volume":"13","author":"Modi","year":"2018","journal-title":"J Datta Meghe Inst Med Sci Univ"},{"key":"R13-20260422","doi-asserted-by":"crossref","first-page":"515","DOI":"10.22271\/27069567.2021.v3.i1i.194","article-title":"Extra-pulmonary tuberculosis (EPTB): Study of clinico-demographic profile, and comparison of microbiological diagnostic modalities with special emphasis on role of CBNAAT in detecting rifampicin resistance in fluid specimens","volume":"3","author":"Singh","year":"2021","journal-title":"Int J Adv Res Med"},{"key":"R14-20260422","doi-asserted-by":"crossref","first-page":"443","DOI":"10.4103\/lungindia.lungindia_165_22","article-title":"Diagnostic yield of CBNAAT in the diagnosis of extrapulmonary tuberculosis: A prospective observational study","volume":"39","author":"Nishal","year":"2022","journal-title":"Lung India"},{"key":"R15-20260422","doi-asserted-by":"crossref","first-page":"e044096","DOI":"10.1136\/bmjopen-2020-044096","article-title":"Assessment of burden of drug-resistant tuberculosis at a tertiary care Centre in Northern India: A prospective single Centre cohort study","volume":"11","author":"Misra","year":"2021","journal-title":"BMJ Open"},{"key":"R16-20260422","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.17826\/cumj.737325","article-title":"Epidemiological profile of extrapulmonary tuberculosis cases: 4 year-experience","volume":"45","author":"P\u0131nar","year":"2020","journal-title":"Cukurova Medical Journal"},{"key":"R17-20260422","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.18203\/2320-6012.ijrms20223094","article-title":"A retrospective analysis of drug resistance in M. tuberculosis and role of CBNAAT, LPA and culture in diagnosis","volume":"10","author":"Wadhwa","year":"2022","journal-title":"Int J Res Med Sci"},{"key":"R18-20260422","doi-asserted-by":"crossref","first-page":"e0258295","DOI":"10.1371\/journal.pone.0258295","article-title":"Drug resistance and its risk factors among extrapulmonary tuberculosis in Ethiopia: A systematic review and meta-analysis","volume":"16","author":"Diriba","year":"2021","journal-title":"PLoS One"},{"key":"R19-20260422","first-page":"e50222","article-title":"Multi-drug resistance tuberculosis (MDR-TB) challenges in India: A review","volume":"15","author":"Vishwakarma","year":"2023","journal-title":"Cureus"},{"key":"R20-20260422","doi-asserted-by":"crossref","first-page":"112","DOI":"10.4103\/bbrj.bbrj_26_18","article-title":"Epidemiology of multi-drug-resistant tuberculosis in Northern India","volume":"2","author":"Kumar","year":"2018","journal-title":"Biomed Biotechnol Res J"}],"container-title":["The International Journal of Mycobacteriology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijmy.ijmy_17_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:56:20Z","timestamp":1786647380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijmy.ijmy_17_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijmy.ijmy_17_25","relation":{},"ISSN":["2212-5531","2212-554X"],"issn-type":[{"value":"2212-5531","type":"print"},{"value":"2212-554X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2025-02-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-05","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}