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Why being an expert – despite xpert –remains crucial for children in high TB burden settings

BACKGROUND: As access to Xpert expands in high TB-burden settings, its performance against clinically diagnosed TB as a reference standard provides important insight as the majority of childhood TB is bacteriologically unconfirmed. We aim to describe the characteristics and outcomes of children with...

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Autores principales: Bacha, Jason M., Ngo, Katherine, Clowes, Petra, Draper, Heather R., Ntinginya, Elias N., DiNardo, Andrew, Mangu, Chacha, Sabi, Issa, Mtafya, Bariki, Mandalakas, Anna M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294844/
https://www.ncbi.nlm.nih.gov/pubmed/28166728
http://dx.doi.org/10.1186/s12879-017-2236-9
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author Bacha, Jason M.
Ngo, Katherine
Clowes, Petra
Draper, Heather R.
Ntinginya, Elias N.
DiNardo, Andrew
Mangu, Chacha
Sabi, Issa
Mtafya, Bariki
Mandalakas, Anna M.
author_facet Bacha, Jason M.
Ngo, Katherine
Clowes, Petra
Draper, Heather R.
Ntinginya, Elias N.
DiNardo, Andrew
Mangu, Chacha
Sabi, Issa
Mtafya, Bariki
Mandalakas, Anna M.
author_sort Bacha, Jason M.
collection PubMed
description BACKGROUND: As access to Xpert expands in high TB-burden settings, its performance against clinically diagnosed TB as a reference standard provides important insight as the majority of childhood TB is bacteriologically unconfirmed. We aim to describe the characteristics and outcomes of children with presumptive TB and TB disease, and assess performance of Xpert under programmatic conditions against a clinical diagnosis of TB as a reference standard. METHODS: Retrospective review of children evaluated for presumptive TB in Mbeya, Tanzania. Baseline characteristics were compared by TB disease status and, for patients diagnosed with TB, by TB confirmation status using Wilcoxon rank sum test for continuous variables and the Chi-square test for categorical variables. Sensitivity and specificity were calculated to assess the performance of Xpert, smear, and culture against clinical TB. Kappa statistics were calculated to assess agreement between Xpert and smear to culture. RESULTS: Among children (N = 455) evaluated for presumptive TB, 70.3% (320/455) had Xpert and 62.8% (286/455) had culture performed on sputa. 34.5% (157/455) were diagnosed with TB: 80.3% (126/157) pulmonary TB, 13.4% (21/157) bacteriologically confirmed, 53.5% (84/157) HIV positive, and 48.4% (76/157) inpatients. Compared to the reference standard of clinical diagnosis, sensitivity of Xpert was 8% (95% CI 4–15), smear 6% (95% CI 3–12) and culture 16% (95% CI 9–24), and did not differ based on patient disposition, nutrition or HIV status. CONCLUSION: Despite access to Xpert, the majority of children with presumptive TB were treated based on clinical diagnosis. Reflecting the reality of clinical practice in resource limited settings, new diagnostics such as Xpert serve as important adjunctive tests but will not obviate the need for astute clinicians and comprehensive diagnostic algorithms. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-017-2236-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-52948442017-02-09 Why being an expert – despite xpert –remains crucial for children in high TB burden settings Bacha, Jason M. Ngo, Katherine Clowes, Petra Draper, Heather R. Ntinginya, Elias N. DiNardo, Andrew Mangu, Chacha Sabi, Issa Mtafya, Bariki Mandalakas, Anna M. BMC Infect Dis Research Article BACKGROUND: As access to Xpert expands in high TB-burden settings, its performance against clinically diagnosed TB as a reference standard provides important insight as the majority of childhood TB is bacteriologically unconfirmed. We aim to describe the characteristics and outcomes of children with presumptive TB and TB disease, and assess performance of Xpert under programmatic conditions against a clinical diagnosis of TB as a reference standard. METHODS: Retrospective review of children evaluated for presumptive TB in Mbeya, Tanzania. Baseline characteristics were compared by TB disease status and, for patients diagnosed with TB, by TB confirmation status using Wilcoxon rank sum test for continuous variables and the Chi-square test for categorical variables. Sensitivity and specificity were calculated to assess the performance of Xpert, smear, and culture against clinical TB. Kappa statistics were calculated to assess agreement between Xpert and smear to culture. RESULTS: Among children (N = 455) evaluated for presumptive TB, 70.3% (320/455) had Xpert and 62.8% (286/455) had culture performed on sputa. 34.5% (157/455) were diagnosed with TB: 80.3% (126/157) pulmonary TB, 13.4% (21/157) bacteriologically confirmed, 53.5% (84/157) HIV positive, and 48.4% (76/157) inpatients. Compared to the reference standard of clinical diagnosis, sensitivity of Xpert was 8% (95% CI 4–15), smear 6% (95% CI 3–12) and culture 16% (95% CI 9–24), and did not differ based on patient disposition, nutrition or HIV status. CONCLUSION: Despite access to Xpert, the majority of children with presumptive TB were treated based on clinical diagnosis. Reflecting the reality of clinical practice in resource limited settings, new diagnostics such as Xpert serve as important adjunctive tests but will not obviate the need for astute clinicians and comprehensive diagnostic algorithms. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-017-2236-9) contains supplementary material, which is available to authorized users. BioMed Central 2017-02-06 /pmc/articles/PMC5294844/ /pubmed/28166728 http://dx.doi.org/10.1186/s12879-017-2236-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Bacha, Jason M.
Ngo, Katherine
Clowes, Petra
Draper, Heather R.
Ntinginya, Elias N.
DiNardo, Andrew
Mangu, Chacha
Sabi, Issa
Mtafya, Bariki
Mandalakas, Anna M.
Why being an expert – despite xpert –remains crucial for children in high TB burden settings
title Why being an expert – despite xpert –remains crucial for children in high TB burden settings
title_full Why being an expert – despite xpert –remains crucial for children in high TB burden settings
title_fullStr Why being an expert – despite xpert –remains crucial for children in high TB burden settings
title_full_unstemmed Why being an expert – despite xpert –remains crucial for children in high TB burden settings
title_short Why being an expert – despite xpert –remains crucial for children in high TB burden settings
title_sort why being an expert – despite xpert –remains crucial for children in high tb burden settings
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294844/
https://www.ncbi.nlm.nih.gov/pubmed/28166728
http://dx.doi.org/10.1186/s12879-017-2236-9
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