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Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children

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 assesse...

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Autores principales: Kabir, Senjuti, Rahman, S M Mazidur, Ahmed, Shakil, Islam, Md Shamiul, Banu, Rupali Sisir, Shewade, Hemant Deepak, Thekkur, Pruthu, Anwar, Sayeeda, Banu, Nazneen Akhter, Nasrin, Rumana, Uddin, Mohammad Khaja Mafij, Choudhury, Sabrina, Ahmed, Shahriar, Paul, Kishor Kumar, Khatun, Razia, Chisti, Mohammod Jobayer, Banu, Sayera
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8521743/
https://www.ncbi.nlm.nih.gov/pubmed/32421765
http://dx.doi.org/10.1093/cid/ciaa583
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author Kabir, Senjuti
Rahman, S M Mazidur
Ahmed, Shakil
Islam, Md Shamiul
Banu, Rupali Sisir
Shewade, Hemant Deepak
Thekkur, Pruthu
Anwar, Sayeeda
Banu, Nazneen Akhter
Nasrin, Rumana
Uddin, Mohammad Khaja Mafij
Choudhury, Sabrina
Ahmed, Shahriar
Paul, Kishor Kumar
Khatun, Razia
Chisti, Mohammod Jobayer
Banu, Sayera
author_facet Kabir, Senjuti
Rahman, S M Mazidur
Ahmed, Shakil
Islam, Md Shamiul
Banu, Rupali Sisir
Shewade, Hemant Deepak
Thekkur, Pruthu
Anwar, Sayeeda
Banu, Nazneen Akhter
Nasrin, Rumana
Uddin, Mohammad Khaja Mafij
Choudhury, Sabrina
Ahmed, Shahriar
Paul, Kishor Kumar
Khatun, Razia
Chisti, Mohammod Jobayer
Banu, Sayera
author_sort Kabir, Senjuti
collection PubMed
description 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.
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spelling pubmed-85217432021-10-19 Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children Kabir, Senjuti Rahman, S M Mazidur Ahmed, Shakil Islam, Md Shamiul Banu, Rupali Sisir Shewade, Hemant Deepak Thekkur, Pruthu Anwar, Sayeeda Banu, Nazneen Akhter Nasrin, Rumana Uddin, Mohammad Khaja Mafij Choudhury, Sabrina Ahmed, Shahriar Paul, Kishor Kumar Khatun, Razia Chisti, Mohammod Jobayer Banu, Sayera Clin Infect Dis Major Articles and Commentaries 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. Oxford University Press 2020-05-18 /pmc/articles/PMC8521743/ /pubmed/32421765 http://dx.doi.org/10.1093/cid/ciaa583 Text en © The Author(s) 2020. Published by Oxford University Press for the 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 and Commentaries
Kabir, Senjuti
Rahman, S M Mazidur
Ahmed, Shakil
Islam, Md Shamiul
Banu, Rupali Sisir
Shewade, Hemant Deepak
Thekkur, Pruthu
Anwar, Sayeeda
Banu, Nazneen Akhter
Nasrin, Rumana
Uddin, Mohammad Khaja Mafij
Choudhury, Sabrina
Ahmed, Shahriar
Paul, Kishor Kumar
Khatun, Razia
Chisti, Mohammod Jobayer
Banu, Sayera
Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children
title Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children
title_full Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children
title_fullStr Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children
title_full_unstemmed Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children
title_short Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children
title_sort xpert ultra assay on stool to diagnose pulmonary tuberculosis in children
topic Major Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8521743/
https://www.ncbi.nlm.nih.gov/pubmed/32421765
http://dx.doi.org/10.1093/cid/ciaa583
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