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Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis

BACKGROUND: Difficult specimen collection and low bacillary load make microbiological confirmation of tuberculosis (TB) in children challenging. In this study, we conducted a systematic review and meta-analysis to assess the diagnostic accuracy of Xpert on stool for pediatric tuberculosis. METHODS:...

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Autores principales: Gebre, Meseret, Cameron, Lindsay Hatzenbuehler, Tadesse, Getachew, Woldeamanuel, Yohannes, Wassie, Liya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378590/
https://www.ncbi.nlm.nih.gov/pubmed/34430668
http://dx.doi.org/10.1093/ofid/ofaa627
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author Gebre, Meseret
Cameron, Lindsay Hatzenbuehler
Tadesse, Getachew
Woldeamanuel, Yohannes
Wassie, Liya
author_facet Gebre, Meseret
Cameron, Lindsay Hatzenbuehler
Tadesse, Getachew
Woldeamanuel, Yohannes
Wassie, Liya
author_sort Gebre, Meseret
collection PubMed
description BACKGROUND: Difficult specimen collection and low bacillary load make microbiological confirmation of tuberculosis (TB) in children challenging. In this study, we conducted a systematic review and meta-analysis to assess the diagnostic accuracy of Xpert on stool for pediatric tuberculosis. METHODS: Our search included studies from 2011 through 2019, and specific search terms were used to retrieve articles from Pubmed, EMBASE, BIOSIS, ClinicalTrials.gov, and Google Scholar. Risk of bias was assessed using the QUADAS 2 tool. The protocol was registered in PROSPERO (CRD42018083637). Summary estimates of sensitivity and specificity were conducted using meta-disc Software assuming a random-effects model. RESULTS: We identified 12 eligible studies, which included data from 2177 children, of whom 295 (13.6%) had bacteriologically confirmed TB on respiratory specimens. The pooled sensitivity of Xpert MTB/RIF on stool specimens compared with bacteriologically confirmed tuberculosis with respiratory specimens was 0.50 (95% CI, 0.44–0.56) with an I(2) of 86%, which was statistically significant (P < .001). The pooled specificity was 0.99 (95% CI, 0.98–0.99; I(2) = 0.0%; P = .44). CONCLUSIONS: Despite the observed heterogeneity, stool may be considered an additional specimen to support diagnosis of pulmonary TB in children, especially in settings where it is impossible to get respiratory samples. Further studies should evaluate its optimization as a diagnostic tool.
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spelling pubmed-83785902021-08-23 Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis Gebre, Meseret Cameron, Lindsay Hatzenbuehler Tadesse, Getachew Woldeamanuel, Yohannes Wassie, Liya Open Forum Infect Dis Major Articles BACKGROUND: Difficult specimen collection and low bacillary load make microbiological confirmation of tuberculosis (TB) in children challenging. In this study, we conducted a systematic review and meta-analysis to assess the diagnostic accuracy of Xpert on stool for pediatric tuberculosis. METHODS: Our search included studies from 2011 through 2019, and specific search terms were used to retrieve articles from Pubmed, EMBASE, BIOSIS, ClinicalTrials.gov, and Google Scholar. Risk of bias was assessed using the QUADAS 2 tool. The protocol was registered in PROSPERO (CRD42018083637). Summary estimates of sensitivity and specificity were conducted using meta-disc Software assuming a random-effects model. RESULTS: We identified 12 eligible studies, which included data from 2177 children, of whom 295 (13.6%) had bacteriologically confirmed TB on respiratory specimens. The pooled sensitivity of Xpert MTB/RIF on stool specimens compared with bacteriologically confirmed tuberculosis with respiratory specimens was 0.50 (95% CI, 0.44–0.56) with an I(2) of 86%, which was statistically significant (P < .001). The pooled specificity was 0.99 (95% CI, 0.98–0.99; I(2) = 0.0%; P = .44). CONCLUSIONS: Despite the observed heterogeneity, stool may be considered an additional specimen to support diagnosis of pulmonary TB in children, especially in settings where it is impossible to get respiratory samples. Further studies should evaluate its optimization as a diagnostic tool. Oxford University Press 2020-12-28 /pmc/articles/PMC8378590/ /pubmed/34430668 http://dx.doi.org/10.1093/ofid/ofaa627 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Articles
Gebre, Meseret
Cameron, Lindsay Hatzenbuehler
Tadesse, Getachew
Woldeamanuel, Yohannes
Wassie, Liya
Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis
title Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis
title_full Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis
title_fullStr Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis
title_full_unstemmed Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis
title_short Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis
title_sort variable diagnostic performance of stool xpert in pediatric tuberculosis: a systematic review and meta-analysis
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378590/
https://www.ncbi.nlm.nih.gov/pubmed/34430668
http://dx.doi.org/10.1093/ofid/ofaa627
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