Lin Sun1,2, Xue Qi1,2, Fang Liu2,3, Xirong Wu2,4, Qingqin Yin2,4, Yan Guo2,4, Baoping Xu2,4, Anxia Jiao2,3, Yajie Guo1,2, Weiwei Jiao1,2, Chen Shen5,2, Jing Xiao1,2, Adong Shen5,2. 1. Bejing Key Laboratory of Pediatric Respiratory Infectious Diseases, Beijing Pediatric Research Institute, Beijing, China. 2. National Clinical Research Center for Respiratory Disease, National Key Discipline of Pediatrics, Key Laboratory of Major Diseases in Children, and National Center for Children's Health, Ministry of Education of the People's Republic of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; and. 3. Interventional Pulmonary Department and. 4. Department of Respiratory Medicine, Beijing Children's Hospital, Beijing, China. 5. Bejing Key Laboratory of Pediatric Respiratory Infectious Diseases, Beijing Pediatric Research Institute, Beijing, China; shenad16@hotmail.com.
Abstract
OBJECTIVES: Xpert Mycobacterium tuberculosis and rifampicin (MTB/RIF) Ultra assay has increasingly been used in adult tuberculosis diagnosis, but data relating to its diagnostic accuracy in children are lacking. Because a qualified sputum specimen is difficult to obtain in children, this study evaluated the diagnostic value of Ultra in childhood tuberculosis using bronchoalveolar lavage fluid. METHODS: The accuracy of Ultra was calculated by using bacteriologic results and clinical evidence as reference standards. Concordance between Ultra and Xpert MTB/RIF assays was assessed by using к coefficients. RESULTS: In total, 93 children with pulmonary tuberculosis and 128 children with respiratory tract infections were enrolled. The sensitivity of Ultra, in all pulmonary tuberculosis cases and in bacteriologically confirmed tuberculosis cases, was 70% and 91%, respectively. Ultra could detect Mycobacterium tuberculosis in 58% of cases with negative culture or acid-fast-staining results. The specificity of Ultra was 98%. There was no significant difference in sensitivity between samples with a volume ≤1 and >1 mL (66% vs 73%; P = .50; odds ratio [OR] = 0.71). Among 164 children for which Ultra and Xpert were simultaneously performed, the sensitivity was 80% and 67%, respectively, indicating good agreement (к = 0.84). An additional 6 children were identified as Ultra-positive but Xpert-negative. The positive rate decreased from 93% to 63% after 1 month (P = .01; OR = 0.12) and to 71% after 2 months (P = .03; OR = 0.18) of antituberculosis treatment. CONCLUSIONS: Ultra using bronchoalveolar lavage fluid has good sensitivity compared with bacteriologic tests and adds clinical value by assisting the rapid and accurate diagnosis of pulmonary tuberculosis in children.
OBJECTIVES: Xpert Mycobacterium tuberculosis and rifampicin (MTB/RIF) Ultra assay has increasingly been used in adult tuberculosis diagnosis, but data relating to its diagnostic accuracy in children are lacking. Because a qualified sputum specimen is difficult to obtain in children, this study evaluated the diagnostic value of Ultra in childhood tuberculosis using bronchoalveolar lavage fluid. METHODS: The accuracy of Ultra was calculated by using bacteriologic results and clinical evidence as reference standards. Concordance between Ultra and Xpert MTB/RIF assays was assessed by using к coefficients. RESULTS: In total, 93 children with pulmonary tuberculosis and 128 children with respiratory tract infections were enrolled. The sensitivity of Ultra, in all pulmonary tuberculosis cases and in bacteriologically confirmed tuberculosis cases, was 70% and 91%, respectively. Ultra could detect Mycobacterium tuberculosis in 58% of cases with negative culture or acid-fast-staining results. The specificity of Ultra was 98%. There was no significant difference in sensitivity between samples with a volume ≤1 and >1 mL (66% vs 73%; P = .50; odds ratio [OR] = 0.71). Among 164 children for which Ultra and Xpert were simultaneously performed, the sensitivity was 80% and 67%, respectively, indicating good agreement (к = 0.84). An additional 6 children were identified as Ultra-positive but Xpert-negative. The positive rate decreased from 93% to 63% after 1 month (P = .01; OR = 0.12) and to 71% after 2 months (P = .03; OR = 0.18) of antituberculosis treatment. CONCLUSIONS: Ultra using bronchoalveolar lavage fluid has good sensitivity compared with bacteriologic tests and adds clinical value by assisting the rapid and accurate diagnosis of pulmonary tuberculosis in children.
Authors: Alexander W Kay; Tara Ness; Sabine E Verkuijl; Kerri Viney; Annemieke Brands; Tiziana Masini; Lucia González Fernández; Michael Eisenhut; Anne K Detjen; Anna M Mandalakas; Karen R Steingart; Yemisi Takwoingi Journal: Cochrane Database Syst Rev Date: 2022-09-06
Authors: Willy Ssengooba; Jean de Dieu Iragena; Lydia Nakiyingi; Serestine Mujumbi; Eric Wobudeya; Robert Mboizi; David Boulware; David B Meya; Louise Choo; Angela M Crook; Kristen Lebeau; Moses Joloba; Anne-Marie Demers; Fiona V Cresswell; Diana M Gibb Journal: J Clin Microbiol Date: 2020-08-24 Impact factor: 5.948
Authors: Claudia Signorino; Martina Votto; Maria De Filippo; Gian Luigi Marseglia; Luisa Galli; Elena Chiappini Journal: Pediatr Allergy Immunol Date: 2022-01 Impact factor: 5.464