ArticleJournal of clinical tuberculosis and other mycobacterial diseases2026
Diagnostic utility of Xpert MTB/RIF ultra in clinically suspected tuberculous lymphadenitis in low-burden settings: a single center experience from Saudi Arabia.
Article in Journal of clinical tuberculosis and other mycobacterial diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Tuberculosis (TB) is a major global health issue, particularly among HIV-positive individuals. In Saudi Arabia, the incidence has declined to 8.4 per 100,000 but remains a concern among high-risk groups. Extrapulmonary TB, especially tuberculous lymphadenitis (TBL), is challenging to diagnose due to the low sensitivity of smear, culture, and histopathology. Xpert MTB/RIF Ultra (Xpert-Ultra) offers improved detection in paucibacillary disease, though local evidence remains limited. Method: We retrospectively reviewed 85 adult patients with suspected TBL at King Abdulaziz Medical City, Riyadh (2012-2024). Clinical, radiological, histopathological, and microbiological data were collected. The sensitivity of Xpert-Ultra, GeneXpert, and ProbTec was assessed against a composite reference standard comprising confirmed and presumed TB cases. Result: Among 85 patients, the majority were males (55.3%) and Saudi nationals (91.8%), with most aged 41-65 years (36.5%). Cervical lymphadenopathy was the most common presentation (64.7%). Necrotizing granulomas were observed in 78.8% of biopsies. Culture was positive in 43.6% (17/39), while AFB staining was detected in 14.8% (12/81). Overall, PCR sensitivity was 38.8% (33/85). Xpert-Ultra achieved higher sensitivity (41.3%) compared with GeneXpert (31.6%) and ProbTec (33.3%). Xpert-Ultra missed two culture-positive cases but detected three culture-negative ones. PCR positivity was associated with extensive lymph node involvement and culture positivity. Conclusion: Xpert-Ultra outperformed older molecular assays but remained insufficient as a standalone diagnostic tool for TBL. Its complementary role alongside histopathology and culture supports its integration into diagnostic pathways, potentially improving time to initiation of treatment.
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