Line probe assay 26 7-15

CME Presentation at Department of Pathology

1. Line Probe Assay: A New Arrival at the PRL Dr. Muhammad Yahya Noori Assistant Professor Department of Pathology DIMC Focal Person for Provincial Tuberculosis Reference Lab Sindh DUHS

2. Tuberculosis Most common infectious cause of Mortality after HIV/AIDS 2

3. The Cost 2013 1.5 Million Deaths 9 Million New Cases Drug Sensitive TB $100-500/case MDR TB $9000-48000/case 3

4. Pakistan Burden of Disease 4

5. Pakistan New Cases 5

6. Drug Resistant Tuberculosis 6

7. Case Notification in Pakistan 7

8. Diagnosis of tuberculosis Latent Infection Active tuberculosis Smear examination Solid and liquid culture Identification Susceptibility testing methods TST IFN-  techniques Molecular methods Detection Identification Detection of resistance 8

9. Xpert MTB/RIF Assay Meta-Analysis Study Average sensitivity for detection of rifampicin resistance: 94.1% Average specificity for detection of rifampicin resistance: 97.0% Average sensitivity in extra-pulmonary specimens: 80.4% Average specificity in extra-pulmonary specimens : 86.1% 9

10. WHO Evaluation on Xpert MTB/RIF Assay-2011 Xpert MTB/RIF assay: Analytical sensitivity: 5 genome copies/purified DNA or 131 cfu/ml sputum (10-100 cfu/ml sputum for culture) 10

11. 11 Simultaneous Detection of Rifampicin and INH Resistance

12. 12

13. 13 Strip Reading

14. 14 For Smear Positive specimens: Rifampicin : Sensitivity >97% Specificity >99% In combination with INH: Sensitivity >90% Specificity >99 % Sensitivity and Specificity

15. Thank you 15