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  • LPA for DR-TB Diagnosis

    Learning Objectives

    Explain the role of LPA in the diagnosis of DRTB including both FL and SL LPA.

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As per the Integrated Drug Resistant Tuberculosis (DR-TB) Diagnostic Algorithm:

 

  • Nucleic Acid Amplification Test (NAAT) are preferred for initial detection of Rifampicin (R) resistance.
  • Line Probe Assay (LPA) test is preferred for detection of Isoniazid (H), Fluroquinolones (FQ) and second-line injectable (SLI) drugs resistance.
    • When Rifampicin resistance is detected by NAAT (Figure):
      • Offer first-line (FL) and second line (SL) LPA
      • Direct LPA performed on smear positive specimen or indirect LPA is performed on culture isolate when smear is negative
    • When Rifampicin resistance is not detected by NAAT (Figure):
      • Offer FL-LPA to detect H resistance
      • Direct LPA performed on smear positive specimen or indirect LPA is performed on culture isolate when smear is negative
      • If H resistance is detected, SL-LPA is performed to check FQ resistance.

 

Figure: Flow Chart to decide FL/SL-LPA after NAAT Results

 

 

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