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Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method
The microbiological diagnosis of tuberculosis (TB) in children is challenging, as it relies on the collection of relatively invasive specimens by trained health care workers, which is not feasible in many settings. Mycobacterium tuberculosis is detectable from the stools of children using molecular...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society for Microbiology
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113478/ https://www.ncbi.nlm.nih.gov/pubmed/29997199 http://dx.doi.org/10.1128/JCM.00781-18 |
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author | Walters, Elisabetta Scott, Lesley Nabeta, Pamela Demers, Anne-Marie Reubenson, Gary Bosch, Corné David, Anura van der Zalm, Marieke Havumaki, Joshua Palmer, Megan Hesseling, Anneke C. Ncayiyana, Jabulani Stevens, Wendy Alland, David Denkinger, Claudia Banada, Padmapriya |
author_facet | Walters, Elisabetta Scott, Lesley Nabeta, Pamela Demers, Anne-Marie Reubenson, Gary Bosch, Corné David, Anura van der Zalm, Marieke Havumaki, Joshua Palmer, Megan Hesseling, Anneke C. Ncayiyana, Jabulani Stevens, Wendy Alland, David Denkinger, Claudia Banada, Padmapriya |
author_sort | Walters, Elisabetta |
collection | PubMed |
description | The microbiological diagnosis of tuberculosis (TB) in children is challenging, as it relies on the collection of relatively invasive specimens by trained health care workers, which is not feasible in many settings. Mycobacterium tuberculosis is detectable from the stools of children using molecular methods, but processing stool specimens is resource intensive. We evaluated a novel, simple, centrifugation-free processing method for stool specimens for use on the Xpert MTB/RIF assay (Xpert), using two different stool masses: 0.6 g and a swab sample. Two hundred eighty children (median age, 15.5 months; 35 [12.5%] HIV infected) with suspected intrathoracic TB were enrolled from two sites in South Africa. Compared to a single Xpert test on respiratory specimens, the sensitivity of Xpert on stools using the 0.6-g and swab samples was 44.4% (95% confidence interval [CI], 13.7 to 78.8%) for both methods, with a specificity of >99%. The combined sensitivities of two stool tests versus the first respiratory Xpert were 70.0% (95% CI, 34.8 to 93.3) and 50.0% (95% CI, 18.7 to 81.3) for the 0.6-g and swab sample, respectively. Retesting stool specimens with nondeterminate Xpert results improved nondeterminate rates from 9.3% to 3.9% and from 8.6% to 4.3% for 0.6-g and swab samples, respectively. Overall, stool Xpert detected 14/94 (14.9%) children who initiated antituberculosis treatment, while respiratory specimens detected 23/94 (24.5%). This stool processing method is well suited for settings with low capacity for respiratory specimen collection. However, the overall sensitivity to detect confirmed and clinical TB was lower than that of respiratory specimens. More sensitive rapid molecular assays are needed to improve the utility of stools for the diagnosis of intrathoracic TB in children from resource-limited settings. |
format | Online Article Text |
id | pubmed-6113478 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | American Society for Microbiology |
record_format | MEDLINE/PubMed |
spelling | pubmed-61134782018-08-31 Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method Walters, Elisabetta Scott, Lesley Nabeta, Pamela Demers, Anne-Marie Reubenson, Gary Bosch, Corné David, Anura van der Zalm, Marieke Havumaki, Joshua Palmer, Megan Hesseling, Anneke C. Ncayiyana, Jabulani Stevens, Wendy Alland, David Denkinger, Claudia Banada, Padmapriya J Clin Microbiol Mycobacteriology and Aerobic Actinomycetes The microbiological diagnosis of tuberculosis (TB) in children is challenging, as it relies on the collection of relatively invasive specimens by trained health care workers, which is not feasible in many settings. Mycobacterium tuberculosis is detectable from the stools of children using molecular methods, but processing stool specimens is resource intensive. We evaluated a novel, simple, centrifugation-free processing method for stool specimens for use on the Xpert MTB/RIF assay (Xpert), using two different stool masses: 0.6 g and a swab sample. Two hundred eighty children (median age, 15.5 months; 35 [12.5%] HIV infected) with suspected intrathoracic TB were enrolled from two sites in South Africa. Compared to a single Xpert test on respiratory specimens, the sensitivity of Xpert on stools using the 0.6-g and swab samples was 44.4% (95% confidence interval [CI], 13.7 to 78.8%) for both methods, with a specificity of >99%. The combined sensitivities of two stool tests versus the first respiratory Xpert were 70.0% (95% CI, 34.8 to 93.3) and 50.0% (95% CI, 18.7 to 81.3) for the 0.6-g and swab sample, respectively. Retesting stool specimens with nondeterminate Xpert results improved nondeterminate rates from 9.3% to 3.9% and from 8.6% to 4.3% for 0.6-g and swab samples, respectively. Overall, stool Xpert detected 14/94 (14.9%) children who initiated antituberculosis treatment, while respiratory specimens detected 23/94 (24.5%). This stool processing method is well suited for settings with low capacity for respiratory specimen collection. However, the overall sensitivity to detect confirmed and clinical TB was lower than that of respiratory specimens. More sensitive rapid molecular assays are needed to improve the utility of stools for the diagnosis of intrathoracic TB in children from resource-limited settings. American Society for Microbiology 2018-08-27 /pmc/articles/PMC6113478/ /pubmed/29997199 http://dx.doi.org/10.1128/JCM.00781-18 Text en Copyright © 2018 Walters et al. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Mycobacteriology and Aerobic Actinomycetes Walters, Elisabetta Scott, Lesley Nabeta, Pamela Demers, Anne-Marie Reubenson, Gary Bosch, Corné David, Anura van der Zalm, Marieke Havumaki, Joshua Palmer, Megan Hesseling, Anneke C. Ncayiyana, Jabulani Stevens, Wendy Alland, David Denkinger, Claudia Banada, Padmapriya Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method |
title | Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method |
title_full | Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method |
title_fullStr | Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method |
title_full_unstemmed | Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method |
title_short | Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method |
title_sort | molecular detection of mycobacterium tuberculosis from stools in young children by use of a novel centrifugation-free processing method |
topic | Mycobacteriology and Aerobic Actinomycetes |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113478/ https://www.ncbi.nlm.nih.gov/pubmed/29997199 http://dx.doi.org/10.1128/JCM.00781-18 |
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