Xpert MTB/RIF on Stool Is Useful for the Rapid Diagnosis of Tuberculosis in Young Children With Severe Pulmonary Disease

Tuberculosis (TB) continues to result in high morbidity and mortality in children from resource-limited settings. Diagnostic challenges, including resource-intense sputum collection methods and insensitive diagnostic tests, contribute to diagnostic delay and poor outcomes in children. We evaluated t...

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Bibliographic Details
Published in:The Pediatric infectious disease journal Vol. 36; no. 9; p. 837
Main Authors: Walters, Elisabetta, van der Zalm, Marieke Magrieta, Palmer, Megan, Bosch, Corné, Demers, Anne-Marie, Draper, Heather, Goussard, Pierre, Schaaf, Hendrik Simon, Friedrich, Sven Olaf, Whitelaw, Andrew, Warren, Robin, Gie, Robert P, Hesseling, Anneke C
Format: Journal Article
Language:English
Published: United States 01.09.2017
Subjects:
Child
Child, Preschool
Feces - microbiology
Female
Humans
Infant
Infant, Newborn
Male
Molecular Typing
Nucleic Acid Amplification Techniques - methods
Predictive Value of Tests
Prospective Studies
Radiography, Thoracic
Time Factors
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - diagnostic imaging
ISSN:1532-0987, 1532-0987
Online Access:Get more information
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Summary:Tuberculosis (TB) continues to result in high morbidity and mortality in children from resource-limited settings. Diagnostic challenges, including resource-intense sputum collection methods and insensitive diagnostic tests, contribute to diagnostic delay and poor outcomes in children. We evaluated the diagnostic utility of stool Xpert MTB/RIF (Xpert) compared with bacteriologic confirmation (combination of Xpert and culture of respiratory samples). In a hospital-based study in Cape Town, South Africa, we enrolled children younger than 13 years of age with suspected pulmonary TB from April 2012 to August 2015. Standard clinical investigations included tuberculin skin test, chest radiograph and HIV testing. Respiratory samples for smear microscopy, Xpert and liquid culture included gastric aspirates, induced sputum, nasopharyngeal aspirates and expectorated sputum. One stool sample per child was collected and tested using Xpert. Of 379 children enrolled (median age, 15.9 months, 13.7% HIV infected), 73 (19.3%) had bacteriologically confirmed TB. The sensitivity and specificity of stool Xpert versus overall bacteriologic confirmation were 31.9% [95% confidence interval (CI): 21.84%-44.50%] and 99.7% (95% CI: 98.2%-100%), respectively. A total of 23/51 (45.1%) children with bacteriologically confirmed TB with severe disease were stool Xpert positive. Cavities on chest radiograph were associated with Xpert stool positivity regardless of age and other relevant factors [odds ratios (OR) 7.05; 95% CI: 2.16-22.98; P = 0.001]. Stool Xpert can rapidly confirm TB in children who present with radiologic findings suggestive of severe TB. In resource-limited settings where children frequently present with advanced disease, Xpert on stool samples could improve access to rapid diagnostic confirmation and appropriate treatment.
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ISSN:1532-0987
1532-0987
DOI:10.1097/INF.0000000000001563