Senjuti Kabir1, S M Mazidur Rahman1, Shakil Ahmed2, Md Shamiul Islam3,4, Rupali Sisir Banu4, Hemant Deepak Shewade5,6, Pruthu Thekkur5,6, Sayeeda Anwar7, Nazneen Akhter Banu8, Rumana Nasrin1, Mohammad Khaja Mafij Uddin1, Sabrina Choudhury1, Shahriar Ahmed1, Kishor Kumar Paul1,9, Razia Khatun1, Mohammod Jobayer Chisti10, Sayera Banu1. 1. Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh. 2. Department of Paediatrics, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh. 3. Mycobacterium Disease Control, TB-Leprosy & ASP (AIDS STD Program), Directorate General of Health Services, Dhaka, Bangladesh. 4. National Tuberculosis Control Program, Dhaka, Bangladesh. 5. International Union Against Tuberculosis and Lung Disease (The Union), Paris, France. 6. The Union South East Asia Office, New Delhi, India. 7. Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh. 8. Department of Paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. 9. Kirby Institute, University of New South Wales, Kensington, Australia. 10. Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh.
Abstract
BACKGROUND: The World Health Organization recommends the Xpert MTB/RIF Ultra assay for diagnosing pulmonary tuberculosis (PTB) in children. Though stool is a potential alternative to respiratory specimens among children, the diagnostic performance of Xpert Ultra on stool is unknown. Thus, we assessed the diagnostic performance of Xpert Ultra on stool to diagnose PTB in children. METHODS: We conducted a cross-sectional study among consecutively recruited children (< 15 years of age) with presumptive PTB admitted in 4 tertiary care hospitals in Dhaka, Bangladesh, between January 2018 and April 2019. Single induced sputum and stool specimens were subjected to culture, Xpert, and Xpert Ultra. We considered children as bacteriologically confirmed on induced sputum if any test performed on induced sputum was positive for Mycobacterium tuberculosis and bacteriologically confirmed if M. tuberculosis was detected on either induced sputum or stool. RESULTS: Of 447 children, 29 (6.5%) were bacteriologically confirmed on induced sputum and 72 (16.1%) were bacteriologically confirmed. With "bacteriologically confirmed on induced sputum" as a reference, the sensitivity and specificity of Xpert Ultra on stool were 58.6% and 88.1%, respectively. Xpert on stool had sensitivity and specificity of 37.9% and 100.0%, respectively. Among bacteriologically confirmed children, Xpert Ultra on stool was positive in 60 (83.3%), of whom 48 (80.0%) had "trace call." CONCLUSIONS: In children, Xpert Ultra on stool has better sensitivity but lesser specificity than Xpert. A high proportion of Xpert Ultra assays positive on stool had trace call. Future longitudinal studies on clinical evolution are required to provide insight on the management of children with trace call.
BACKGROUND: The World Health Organization recommends the Xpert MTB/RIF Ultra assay for diagnosing pulmonary tuberculosis (PTB) in children. Though stool is a potential alternative to respiratory specimens among children, the diagnostic performance of Xpert Ultra on stool is unknown. Thus, we assessed the diagnostic performance of Xpert Ultra on stool to diagnose PTB in children. METHODS: We conducted a cross-sectional study among consecutively recruited children (< 15 years of age) with presumptive PTB admitted in 4 tertiary care hospitals in Dhaka, Bangladesh, between January 2018 and April 2019. Single induced sputum and stool specimens were subjected to culture, Xpert, and Xpert Ultra. We considered children as bacteriologically confirmed on induced sputum if any test performed on induced sputum was positive for Mycobacterium tuberculosis and bacteriologically confirmed if M. tuberculosis was detected on either induced sputum or stool. RESULTS: Of 447 children, 29 (6.5%) were bacteriologically confirmed on induced sputum and 72 (16.1%) were bacteriologically confirmed. With "bacteriologically confirmed on induced sputum" as a reference, the sensitivity and specificity of Xpert Ultra on stool were 58.6% and 88.1%, respectively. Xpert on stool had sensitivity and specificity of 37.9% and 100.0%, respectively. Among bacteriologically confirmed children, Xpert Ultra on stool was positive in 60 (83.3%), of whom 48 (80.0%) had "trace call." CONCLUSIONS: In children, Xpert Ultra on stool has better sensitivity but lesser specificity than Xpert. A high proportion of Xpert Ultra assays positive on stool had trace call. Future longitudinal studies on clinical evolution are required to provide insight on the management of children with trace call.
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: 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