{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:31:59Z","timestamp":1786739519782,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Existing tests for the diagnosis of pleural tuberculosis (TB) have major limitations in terms of accuracy, time to diagnosis and drug resistance testing. A test which can diagnose pleural TB and detect resistance, like Xpert MTB\/Rif, would be optimal for rapid diagnosis and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A prospective observational study was done in a tertiary care hospital in Eastern Nepal. Fifty-one patients with clinic-radiologic suspicion of pleural TB were included. The results of pleural fluid Xpert MTB\/Rif were compared with two Composite Reference Standards. Composite Reference Standard-1 consisted of positive pleural fluid smear, positive culture, positive histology of pleural biopsy, and positive sputum results. Composite Reference Standard-2 included those with Composite Reference Standard-1 and those with high ADA values (&gt;40 U\/l) with response to anti-tubercular treatment at 8 weeks of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Thirty-six patients were diagnosed as Pleural TB. Nine fulfilled Composite Reference Standard-1. Pleural fluid Xpert MTB\/Rif was positive in five cases with Composite Reference Standard-1 and nine cases with Composite Reference Standard-2. The sensitivity, specificity, positive predictive value and negative predictive value with reference to Composite Reference Standard-1 were 55.56%, 88.10%, 50%, and 90.24%, respectively. Using Composite Reference Standard-2 as reference, sensitivity, specificity, positive predictive value and negative predictive value were 25%, 93.33%, 90%, and 34.15%, respectively. Two cases were diagnosed Xpert Rif resistant on pleural fluid.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Due to low sensitivity, the Xpert MTB\/Rif test cannot be recommended as initial test of diagnosis in a high prevalence setting. At the same time its clinical utility lies in testing of patients suspected to have drug-resistant pleural tuberculosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_256_22","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T05:53:22Z","timestamp":1667973202000},"page":"5956-5960","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Study of diagnostic utility of Xpert MTB\/Rif test on pleural fluid in the evaluation of patients presenting with Pleural Tuberculosis in Nepal"],"prefix":"10.4103","volume":"11","author":[{"given":"Deebya Raj","family":"Mishra","sequence":"first","affiliation":[{"name":"Department of Pulmonary, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Bhatta","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhab","family":"Lamsal","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Critical Care and Sleep Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narayan","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Maskey","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niharika","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"R1-20260527","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12879-018-3196-4","article-title":"Is Xpert MTB\/RIF appropriate for diagnosing tuberculous pleurisy with pleural fluid samples? A systematic review","volume":"18","author":"Huo","year":"2018","journal-title":"BMC Infect Dis"},{"key":"R2-20260527","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1373\/49.1.7","article-title":"The STARD statement for reporting studies of diagnostic accuracy:Explanation and elaboration","volume":"49","author":"Bossuyt","year":"2003","journal-title":"Clin Chem"},{"key":"R3-20260527","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1128\/JCM.02319-10","article-title":"Xpert MTB\/RIF:A new pillar in diagnosis of extrapulmonary tuberculosis?","volume":"49","author":"Vadwai","year":"2011","journal-title":"J Clin Microbiol"},{"key":"R4-20260527","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1001\/archinte.1990.00390180034005","article-title":"Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients","volume":"150","author":"Escudero Bueno","year":"1990","journal-title":"Arch Intern Med"},{"key":"R5-20260527","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1164\/rccm.2111019","article-title":"Yield of sputum induction in the diagnosis of pleural tuberculosis","volume":"167","author":"Conde","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"key":"R6-20260527","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1378\/chest.63.1.88","article-title":"Tuberculous pleurisy","volume":"63","author":"Berger","year":"1973","journal-title":"Chest"},{"key":"R7-20260527","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1136\/bmj.283.6283.20","article-title":"Diagnosing tuberculous pleural effusion:Comparative sensitivity of mycobacterial culture and histopathology","volume":"283","author":"Kumar","year":"1981","journal-title":"Br Med J"},{"key":"R8-20260527","first-page":"33","article-title":"Study of the clinical characteristics and outcomes of patients admitted with exudative pleural effusion:Improving clinical decision making in resource limited setting","volume":"XIV","author":"Mishra","year":"2014","journal-title":"SAARC J Tuberc Lung Dis HIV\/AIDS"},{"key":"R9-20260527","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1186\/s12879-020-05578-3","article-title":"Performance of Xpert\u00aeMTB\/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy","volume":"20","author":"Li","year":"2020","journal-title":"BMC Infect Dis"},{"key":"R10-20260527","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1183\/09031936.00007814","article-title":"Xpert MTB\/RIF assay for the diagnosis of extrapulmonary tuberculosis:A systematic review and meta-analysis","volume":"44","author":"Denkinger","year":"2014","journal-title":"Eur Respir J"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_256_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:29:38Z","timestamp":1786735778000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_256_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":10,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_256_22","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"2022-01-31","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}