Rendimiento de la prueba Xpert MTB/RIF en muestras respiratorias en un escenario real de trabajo de un país en desarrollo

Atehortúa, Santiago; Ramírez, Faiver; Echeverri, Lina; Peñata, Adrián; Ospina, Sigifredo

doi:10.7705/biomedica.v35i1.2330

Cited by 4 publications

(3 citation statements)

References 17 publications

(16 reference statements)

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“…For example, one study shows that it is not difficult to diagnose multidrug-resistant tuberculosis (MDR-TB) in children, since exposure to adults with MDR-TB is essential to establish this presumptive diagnosis [ 6 ]. This result supports the findings of another studies that clinical diagnosis is essential in the management of childhood tuberculosis [ 7 , 25 ], which is why improving the competence of frontline health workers in the priority in most countries as clinical diagnosis of childhood tuberculosis commonly used in clinical practice [ 26 – 29 ].…”

Section: Discussionsupporting

confidence: 88%

“…This result supports the ndings of another studies that clinical diagnosis is essential in the management of childhood tuberculosis [7,25], which is why improving the competence of frontline health workers in the priority in most countries as clinical diagnosis of childhood tuberculosis commonly used in clinical practice [26][27][28][29].…”

Section: Discussionsupporting

confidence: 84%

“…In current times where technologies are rapidly evolving to advance TB care and management [], such advanced technologies are are urgently needed to improve childhood TB case ditection. ( Atehortúa et al, 2015 ; Hajizadeh et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

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Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study

Usmael,

Manyazewal,

Mohammed

et al. 2023

Preprint

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Background Children share 12% of the global 10 million people infected with tuberculosis (TB) each year. Closing case detection gap in children remains difficult, with 56% of all children and 65% under-five with TB missed each year. We aimed to assess the patterns of childhood TB diagnosis and underlying determinants in Ethiopia when different TB diagnostic platforms are applied. Methods A multi-site, cross-sectional study was carried out in Ethiopia as part of the larger EXIT-TB study - evidence-based multiple focused integrated intensified TB screening package. Outpatient children aged ≤ 15 with cough of any duration seeking care at four healthcare facilities in Ethiopia were enrolled consecutively. Participants underwent sputum Xpert MTB/RIF and/or smear microscopy and posteroanterior chest X-ray (CXR), and their clinical and sociodemographic data were captured using a structured questionnaire. Data were analyzed using Stata version 23. Multiple regression model was computed to determine the factors that influence TB case detection, with a 95% confidence interval (CI) and p < 0.05 taken as statistically significant. Results A total of 438 children were enrolled. Of these, 399 had CXR examination of which 55 (13.8%) were suggestive of TB, 270 had Xpert MTB/RIF testing of which 32 (11.9%) were positive, and AFB smear microscopy was done for 51 children of which 2 (3.9%) were positive. Febrile children were more likely to be diagnosed with pulmonary TB than those without fever [aPR = 1.3, 95% CI (1.1–1.4)], and those with a TB contact history were more likely to be diagnosed with pulmonary TB than those with no such contacts [aPR = 1.2, 95% CI (1.1–1.3)]. Children from rural residences were more likely to be diagnosed with TB than those from urban residences [aPR = 1.3, 95% CI (1.1–1.5)]. Conclusion The findings showed that clinical diagnosis remains an important method of TB diagnosis in children and the preferred choice to avert underdiagnosis. A more sensitive TB diagnostic method for children was symptom screening, followed by CXR and Xpert MTB/RIF assay or smear microscopy. Hence, an algorithm that combines clinical, CXR, and microbiological confirmatory tests can improve the rate of pulmonary TB diagnosis in children till more accurate and cost-effective diagnostic tools are accessible. Fever, weight loss, and TB contact history are highly associated with TB positivity rates in children.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 84%

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Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study

Usmael,

Manyazewal,

Mohammed

et al. 2023

Preprint

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Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

Horne

Kohli

Zifodya

et al. 2019

Cochrane Database of Systematic Reviews

173

157

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Background Xpert MTB/RIF (Xpert MTB/RIF) and Xpert MTB/RIF Ultra (Xpert Ultra), the newest version, are the only World Health Organization (WHO)‐recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in persons with signs and symptoms of tuberculosis, at lower health system levels. A previous Cochrane Review found Xpert MTB/RIF sensitive and specific for tuberculosis ( ). Since the previous review, new studies have been published. We performed a review update for an upcoming WHO policy review. Objectives To determine diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB) and for rifampicin resistance in adults with presumptive rifampicin‐resistant tuberculosis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, to 11 October 2018, without language restriction. Selection criteria Randomized trials, cross‐sectional, and cohort studies using respiratory specimens that evaluated Xpert MTB/RIF, Xpert Ultra, or both against the reference standard, culture for tuberculosis and culture‐based drug susceptibility testing or MTBDR plus for rifampicin resistance. Data collection and analysis Four review authors independently extracted data using a standardized form. When possible, we also extracted data by smear and HIV status. We assessed study quality using QUADAS‐2 and performed meta‐analyses to estimate pooled sensitivity and specificity separately for tuberculosis and rifampicin resistance. We investigated potential sources of heterogeneity. Most analyses used a bivariate random‐effects model. For tuberculosis detection, we first estimated accuracy using all included studies and then only the subset of studies where participants were unselected, i.e. not selected based on prior microscopy testing. Main results We identified in total 95 studies (77 new studies since the previous review): 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen. Tuberculosis detection Of the total 86 studies, 45 took place in high tuberculosis burden and 50 in high TB/HIV burden countries. Most studies had low risk of bias. Xpert MTB/RIF pooled sensitivity and specificity (95% credible Interval (CrI)) were 85% (82% to 88%) and 98% (97% to 98%), (70 studies, 37,237 unselected participants; high‐certainty evidence). We found similar accuracy when ...

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Patterns of Childhood Tuberculosis Diagnosis in Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama Regional State, Ethiopia

Taye¹,

Tolesa²,

Tadewos³

et al. 2022

PHMT

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Background: Because of the pauci bacillary nature of childhood tuberculosis and the difficulties in obtaining proper sputum samples from young children, diagnosing childhood tuberculosis (TB) is difficult. Childhood TB needs early identification and care since it advances swiftly to more advanced stages. This study was aimed to determine the patterns of all forms of childhood tuberculosis diagnosis at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Methods: A retrospective cross-sectional study was conducted from February 1, 2017 to January 30, 2021 among 175 children diagnosed and treated for tuberculosis in the pediatric ward. Children medical charts and pediatrics ward logbook were used to extract pertinent data by structured checklists. SPSS version 23.0 was used for data entry and statistical analysis. Results: Of 175 children, fever was the leading clinical symptoms and diagnosed in 166 (94.9%) children followed by weight loss (154, 88%), and cough (136, 77.7%). In twenty seven out of 88 (30.6%) children, gastric aspirate was positive for TB infection by Xpert MTB/Rif, while 3/40 (7.5%) were positive for TB using fine needle aspiration cytology (FNAC), 19/66 (28.8%) had suggestive TB by cerebrospinal fluid analysis (CSF), 10/29 (34.5%) were smear positive for TB and 70/162 (43.2%) were suspected for TB by chest X-ray. Conclusion: Despite recent breakthroughs in quick microbiological detection, such as Xpert MTB/Rif, this study revealed that more than half of the children, 89/175 (51%), were treated for TB diseases solely based on clinical criteria. This will significantly underestimate the true nature of the illness or disease and make them vulnerable to mistreatment. As a result, in order to appropriately treat the disease and manage patients in our settings, getting a microbiological diagnosis of childhood tuberculosis requires improvement, and we call for expanded availability and use of a more sensitive and specific diagnostic technique to circumvent these concerns.

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Rendimiento de la prueba Xpert MTB/RIF en muestras respiratorias en un escenario real de trabajo de un país en desarrollo

Cited by 4 publications

References 17 publications

Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study

Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study

Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

Patterns of Childhood Tuberculosis Diagnosis in Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama Regional State, Ethiopia

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