Genotype MTBDR Plus (Hain) Test in Suspected MDR-TB Patients†
Piamlarp Sangsayunh MD*, Chareon Chuchothawon MD*
Affiliation : † Poster Presentation in European Respiratory Society Conference, September 2013 * Chest Division, Central Chest Institute of Thailand, Nonthaburi, Thailand
Background : Incidence of MDR-TB in Thailand is higher. Diagnosis of multi-drug resistance (MDR-TB) is often delayed
because of insufficient investigations. Therefore, there is a need to introduce an efficient testing method. Genotype MTBDR
plus (Hain test) is a new technology of line probe assay (LPAs) In general practice, it had questionable benefit on negative
and positive direct smear specimens.
Objective : Evaluate the accuracy of the Hain test as compared to the conventional culture and drug susceptibility test (DST),
and evaluate the judgment of the physician on starting MDR-TB treatment after receiving the result of the Hain test.
Material and Method: An observational prospective study was done of 100 suspected MDR-TB patients who visited the
Central Chest Institute of Thailand between September and December 2012. Ninety-four patients were included in the
present study. They were assessed by direct sputum smear test, Hain test, sputum conventional culture, and drug-susceptibility
test (DST) in the first visit. Followed-up treatment until cure/definite treatment were observed for definite diagnosis.
Results : Hain tests identified 65 (69%) MTB positives, 25 (26%) MTB negatives, and four (4%) Non-tuberculous Mycobacteria
(NTM), respectively. Fourteen of 17 negative direct smear but positive Hain test samples were culture negative. We followed
these 14 patients. Four patients with TB treatment were cured. Six patients received MDR treatment and improved. Two
patients were misdiagnosed CA. Two patients had old scar TB lesion. Sensitivity, specificity, and accuracy of Hain test for
MDR-TB detection compared to standard conventional culture were 95%, 86%, and 88%, respectively. Twelve patients were
NTM culture positive. Most of them (75%) were M. abscessus. Sixty-three percent of chest physicians used the result of the
Hain test for extended treatment of standard regimen in non-IR resistance or changing of TB regimen. There was correlation
between judgments of starting MDR-TB treatment and results of Hain test (p = 0.001), no correlation between judgments
of physician and pattern (default/relapse/failure) of previous TB treatment history (p = 0.6), and periods of time from first
diagnosis of TB to develop suspected MDR-TB (p = 0.09) were demonstrated.
Conclusion : We recommend Hain test to diagnose MDR-TB in highly suspected cases, and to wait for conventional culture
results to confirm NTM. Hain test has benefit in negative direct smear.
Keywords : MDR-TB, Genotype MTBDR and MTBDR plus (Hain) test
