title: Bacteriophage- based tests for the detection of Mycobacterium tuberculosis in clinical specimens: a systematic review and meta- analysis.
abstract: BACKGROUND
  Sputum microscopy, the most important conventional test for tuberculosis, is specific in settings with high burden of tuberculosis and low prevalence of non tuberculous mycobacteria. However, the test lacks sensitivity. Although bacteriophage-based tests for tuberculosis have shown promising results, their overall accuracy has not been systematically evaluated.
  
  
  METHODS
  We did a systematic review and meta-analysis of published studies to evaluate the accuracy of phage-based tests for the direct detection of M. tuberculosis in clinical specimens. To identify studies, we searched Medline, EMBASE, Web of science and BIOSIS, and contacted authors, experts and test manufacturers. Thirteen studies, all based on phage amplification method, met our inclusion criteria. Overall accuracy was evaluated using forest plots, summary receiver operating (SROC) curves, and subgroup analyses.
  
  
  RESULTS
  The data suggest that phage-based assays have high specificity (range 0.83 to 1.00), but modest and variable sensitivity (range 0.21 to 0.88). The sensitivity ranged between 0.29 and 0.87 among smear-positive, and 0.13 to 0.78 among smear-negative specimens. The specificity ranged between 0.60 and 0.88 among smear-positive and 0.89 to 0.99 among smear-negative specimens. SROC analyses suggest that overall accuracy of phage-based assays is slightly higher than smear microscopy in direct head-to-head comparisons.
  
  
  CONCLUSIONS
  Phage-based assays have high specificity but lower and variable sensitivity. Their performance characteristics are similar to sputum microscopy. Phage assays cannot replace conventional diagnostic tests such as microscopy and culture at this time. Further research is required to identify methods that can enhance the sensitivity of phage-based assays without compromising the high specificity.
authors: University of California, Berkeley, School of Public Health, 140, Warren Hall, Berkeley, CA 94720, USA. kalantri@berkeley.edu
authors: Shriprakash
authors: S
authors: Kalantri
authors: Madhukar
authors: M
authors: Pai
authors: Lisa
authors: L
authors: Pascopella
authors: Lee
authors: L
authors: Riley
authors: Arthur
authors: A
authors: Reingold
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods* / Q000592:standards*; D001435:Bacteriophages; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification* / Q000821:virology*; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology*