Christian Pohl1, Liliana K Rutaihwa2, Frederick Haraka3, Martin Nsubuga4, Francesco Aloi4, Nyanda E Ntinginya5, Daniel Mapamba5, Norbert Heinrich6, Michael Hoelscher6, Ben J Marais7, Levan Jugheli2, Klaus Reither2. 1. Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Bagamoyo, Tanzania. Electronic address: christian.pohl@unibas.ch. 2. Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Bagamoyo, Tanzania. 3. Ifakara Health Institute, Bagamoyo, Tanzania. 4. St. Francis Hospital Nsambya, AISPO, Kampala, Uganda. 5. NIMR-Mbeya Medical Research Center, Mbeya, Tanzania. 6. Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany. 7. The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
Abstract
OBJECTIVES: We evaluated the ability of the Xpert(®) MTB/RIF assay to detect Mycobacterium tuberculosis in whole blood of children with tuberculosis in tuberculosis endemic settings with high rates of HIV infection. METHODS: From June 2011 to September 2012 we prospectively enrolled children with symptoms or signs suggestive of tuberculosis at three research centres in Tanzania and Uganda. After clinical assessment, respiratory specimens were collected for microscopy and culture, as well as whole blood for Xpert(®) MTB/RIF. Children were classified according to standardised case definitions. RESULTS: A total of 232 children were evaluated; 14 (6.0%) had culture-confirmed tuberculosis. The Xpert(®) MTB/RIF assay detected M. tuberculosis in 5/232 (2.2%) blood samples with 1 (0.4%) error reading and presumably 1 (0.4%) false-positive result. The sensitivity of the assay in children with culture-confirmed (1/14) versus no tuberculosis (1/117) was 7.1% (95% CI, 1.3-31.5). Three of the five Xpert(®) MTB/RIF positive patients had negative cultures, but were classified as probable tuberculosis cases. Assay sensitivity against a composite reference standard (culture-confirmed, highly probable or probable tuberculosis) was 5.4% (95% CI, 2.1-13.1). CONCLUSION: Whole blood Xpert(®) MTB/RIF demonstrated very poor sensitivity, although it may enhance the diagnostic yield in select cases, with culture-negative tuberculosis.
OBJECTIVES: We evaluated the ability of the Xpert(®) MTB/RIF assay to detect Mycobacterium tuberculosis in whole blood of children with tuberculosis in tuberculosis endemic settings with high rates of HIV infection. METHODS: From June 2011 to September 2012 we prospectively enrolled children with symptoms or signs suggestive of tuberculosis at three research centres in Tanzania and Uganda. After clinical assessment, respiratory specimens were collected for microscopy and culture, as well as whole blood for Xpert(®) MTB/RIF. Children were classified according to standardised case definitions. RESULTS: A total of 232 children were evaluated; 14 (6.0%) had culture-confirmed tuberculosis. The Xpert(®) MTB/RIF assay detected M. tuberculosis in 5/232 (2.2%) blood samples with 1 (0.4%) error reading and presumably 1 (0.4%) false-positive result. The sensitivity of the assay in children with culture-confirmed (1/14) versus no tuberculosis (1/117) was 7.1% (95% CI, 1.3-31.5). Three of the five Xpert(®) MTB/RIF positive patients had negative cultures, but were classified as probable tuberculosis cases. Assay sensitivity against a composite reference standard (culture-confirmed, highly probable or probable tuberculosis) was 5.4% (95% CI, 2.1-13.1). CONCLUSION: Whole blood Xpert(®) MTB/RIF demonstrated very poor sensitivity, although it may enhance the diagnostic yield in select cases, with culture-negative tuberculosis.
Authors: Mikashmi Kohli; Ian Schiller; Nandini Dendukuri; Keertan Dheda; Claudia M Denkinger; Samuel G Schumacher; Karen R Steingart Journal: Cochrane Database Syst Rev Date: 2018-08-27
Authors: Tobias Broger; Michael Tsionksy; Anu Mathew; Todd L Lowary; Abraham Pinter; Tatiana Plisova; Daniel Bartlett; Simone Barbero; Claudia M Denkinger; Emmanuel Moreau; Kiyonori Katsuragi; Masanori Kawasaki; Payam Nahid; George B Sigal Journal: PLoS One Date: 2019-04-18 Impact factor: 3.240