PT - JOURNAL ARTICLE AU - Prashant N. Chhajed AU - Preyas J. Vaidya AU - Neha P. Mandovra AU - Vinod B. Chavhan AU - Tejashree T. Lele AU - Rekha Nair AU - Jörg D. Leuppi AU - Avinandan Saha TI - EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy AID - 10.1183/23120541.00008-2019 DP - 2019 Oct 01 TA - ERJ Open Research PG - 00008-2019 VI - 5 IP - 4 4099 - http://openres.ersjournals.com/content/5/4/00008-2019.short 4100 - http://openres.ersjournals.com/content/5/4/00008-2019.full SO - erjor2019 Oct 01; 5 AB - This study aimed to examine the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the rapid diagnosis of mediastinal tuberculous lymphadenitis and drug-resistant mediastinal tuberculous lymphadenitis.A diagnosis of TB was confirmed by a positive Xpert MTB/RIF test or Mycobacterium tuberculosis culture. Rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB) was diagnosed upon the detection of rifampicin resistance by Xpert MTB/RIF or resistance to rifampicin and isoniazid by phenotypic drug susceptibility testing (DST).Xpert MTB/RIF was positive in 43 of 56 patients (77%) and TB culture was positive in 31 of 56 patients (55%). Of these 56 patients, 25 (45%) were Xpert MTB/RIF positive and TB culture negative, 13 (23%) were Xpert MTB/RIF negative and TB culture positive, and 18 (32%) were Xpert MTB/RIF positive and TB culture positive. 11 patients (20%) had drug-resistant TB: seven with RR/MDR-TB, one with pre-extensively drug-resistant (XDR) TB, two with XDR-TB and one with isoniazid mono-resistance.An Xpert MTB/RIF assay carried out on EBUS-TBNA specimens provides rapid diagnosis of TB. Xpert MTB/RIF testing appears to have additional and more rapid sensitivity compared with culture alone. Culture-based DST provides an additional exclusive yield and the full resistance profile in addition to or instead of rifampicin resistance.EBUS-TBNA has value in mediastinal adenopathy, including drug-resistant TB. Combined Xpert MTB/RIF and TB culture testing on EBUS-TBNA specimens helps in diagnosing rifampicin resistance missed by Xpert MTB/RIF. http://bit.ly/2LT2OOD