Contribution of Xpert MTB/RIF to clinical diagnosis in adolescents with tuberculosis in Rio de Janeiro, Brazil

Abstract

SETTING: Rio de Janeiro, RJ, Brazil, a high tuberculosis (TB) burden city.OBJECTIVE: To compare the sociodemographics, clinical characteristics, care process indicators (CPIs) and treatment outcomes among adolescents with pulmonary TB (PTB) and those with PTB + extrapulmonary TB (EPTB), who underwent testing with Xpert® and sputum culture.DESIGN: This was a retrospective study of data from three national databases from 2014 to 2016 of adolescents (aged 10–18 years) residing and notified in Rio de Janeiro City. Three groups were identified according to their Xpert and culture results: Group 1, Xpert- and culture-positive; Group 2, Xpert-positive and culture-negative; and Group 3, Xpert- and culture-negative. Study CPIs were as follows: the time between ‘sample collection and Xpert result release', ‘sample collection and treatment initiation' and ‘notification and treatment outcome'.RESULTS: Of 258 adolescents included in the study, 223 (86.4%) were in Group 1, 20 (7.8%) in Group 2 and 15 (5.8%) in Group 3. Groups 1 and 2 had a similar profile. Compared to Group 1, Group 3 had a higher proportion of HIV-positive cases (21.4% vs. 3.0%, P = 0.016), adolescents with a hospital diagnosis (53.3% vs. 7.6%, P < 0.001), and PTB + EPTB cases (20% vs. 0.4%; P < 0.001). There were no statistically significant differences in CPIs or treatment outcomes.CONCLUSION: The clinical diagnosis was decisive in more critical or complex patients, despite Xpert-negative results.

Detection of Mycobacterium tuberculosis in Pulmonary and Extrapulmonary Samples Using Different Methods: Experience of a Tertiary Care Center in North India

“…The sensitivity and specificity of this assay for smear-negative pulmonary cases (96 and 97%, respectively) were lower than for smear-positive cases (100 and 100%, respectively). Oliveira et al (2019) reported a 7.8% increase in the sensitivity of the Xpert MTB/RIF assay compared to culture [12] . Horne et al (2019) reported a pooled sensitivity of 67% (62-70%) for this assay, and Lombardi et al (2017) reported an improved detection rate of 36.5% by Xpert MTB/ RIF assay in smear-negative pulmonary TB samples [6,11] .…”

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries

“…Xpert MTB/RIF was introduced in 2013 and Xpert MTB/RIF Ultra in 2019. There is likely to be under-detection with bacteriological and clinical diagnosis in adolescents, as well, as suggested by a recent retrospective study of a vulnerable population with poor living conditions in Rio de Janeiro [22]. Since 2011, WHO-recommended treatment regimens for adolescents and children have been applied, and child-friendly dispersible combined formulations are now available.…”

The long-running issues of tuberculosis

“…5 Among deaths from causes other than tuberculosis among adolescents aged 10-18 years with tuberculosis in Rio de Janeiro, 23•8% of deaths are due to violence. 6 The active contact tracing done by the Brazilian Family Health Strategy through home visits, or even the patient search for clinical visits at the health units, can be hindered in settings where violence prevails. Further, the study shows that illicit drug usage is associated with unfavourable outcomes.…”