Tuberculosis diagnosis in resource-limited settings: Clinical use of GeneXpert in the diagnosis of smear-negative PTB: a case report

Background: The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the diagnosis of tuberculosis and drug resistant-tuberculosis. In resource-limited settings, GeneXpert has been used predominantly for research and there is little experience with its use in day-to-day management of patients.
Case summary: We describe a case of a 46 year old HIV-infected male with smear-negative pulmonary tuberculosis, who had several visits to various lower level health centres and two admissions in a tertiary care hospital; however, the diagnosis of tuberculosis was only made several months later on GeneXpert testing that was performed under a research project.
Conclusion: GeneXpert facilitated identification of tuberculosis in an HIV positive patient in whom the diagnosis had been delayed when more widely available tests were used. Operational and cost-effectiveness studies are needed to provide evidence to policy makers in order to improve access to GeneXpert.