The edition · Infectious Diseases
A battery-powered TB test catches 85 in 100
A WHO-supported Cochrane review gives the first pooled accuracy figures for near point-of-care molecular TB testing: good specificity, but less sensitive than Xpert Ultra, and weaker in HIV and smear-negative disease. Plus treatment length in acute hepatitis C, reading antifungal MICs, and a generic itraconazole supplement.
The edition in brief
TB testing: a Cochrane review of five studies and 3,291 participants in nine high-burden countries assessed the only near point-of-care molecular TB test meeting WHO's class definition, a battery-powered sputum assay. Against culture, sensitivity was 85.4% and specificity 97.6% (moderate certainty). Sensitivity fell to 79.2% in people with HIV and 66.7% in smear-negative, culture-positive disease. Head to head, it was 7.5 percentage points less sensitive than Xpert MTB/RIF Ultra with similar specificity, and 22 points more sensitive than smear microscopy. Most studies ran the test in laboratories rather than peripheral clinics, and children were barely represented. Acute hepatitis C: a meta-analysis of 14 mostly single-arm studies and 1,078 patients found pooled cure of 97.7% with dual direct-acting antivirals, rising from 84.8% with 4-week courses and 91.7% with 6 weeks to 99.4% with 8 weeks. Antifungal susceptibility: a Lancet Infectious Diseases Personal View argues that MICs should be reported with interpretation and uncertainty flags, because tolerance, heteroresistance, biofilm, drug exposure and source control all break the link between a susceptible result and cure. Regulatory: FDA recorded a supplement to an Indian manufacturer's generic itraconazole application on 14 September; the record does not say what changed.
Acute hepatitis C: dual DAA cure reached 99% at eight weeks but fell with shorter courses
For acute hepatitis C, treat early and plan at least 8 weeks of dual DAA therapy.
A susceptible antifungal MIC does not guarantee a cure, and reports should say so
Read antifungal MICs with the microbiologist, and look for source, exposure and host factors when a 'susceptible' infection is not responding.
FDA: supplement to a generic itraconazole application from an Indian manufacturer
Note the filing, but make no change to itraconazole prescribing on the basis of it.
A negative molecular TB test does not rule out TB in people with HIV
In symptomatic people with HIV, follow a negative molecular TB test with culture and clinical judgement, not reassurance.
Near point-of-care molecular TB test: 85% sensitive, 98% specific, below Xpert Ultra
Use near point-of-care molecular TB testing where it replaces smear microscopy, not where Xpert-class testing is already available.
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