Stool Xpert MTB/RIF and urine lipoarabinomannan for the diagnosis of tuberculosis in hospitalized HIV-infected children

LaCourse, Sylvia M; Pavlinac, Patricia B; Cranmer, Lisa M; Njuguna, Irene; Mugo, Cyrus; Gatimu, John; Stern, Joshua; Walson, Judd L.; Maleche‐Obimbo, Elizabeth; Oyugi, Julius; Wamalwa, Dalton; John‐Stewart, Grace

doi:10.1097/qad.0000000000001662

Cited by 64 publications

(65 citation statements)

References 34 publications

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“…In addition, we compared the accuracy of OS PCR with that of liquid culture of a single induced sputum specimen. We, and others, have previously shown that there is substantial incremental yield from testing additional respiratory specimens 6,14 , and we therefore have likely over-estimated the sensitivity of OS PCR in relation to true disease status. Additional limitations included a small sample size and a focus on a single geographical area.…”

Section: Discussionmentioning

confidence: 99%

“…One approach to improving TB diagnosis in children is to collect multiple different specimen types with the assumption that the yield would be cumulative. Potentially useful specimen types include gastric aspirates, induced sputum, nasopharyngeal aspirates, stool, urine, and the 'string test' [3][4][5][6] . One of the simplest samples to obtain is a swab of the oral mucosa 7 .…”

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confidence: 99%

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Microbiological diagnosis of pulmonary tuberculosis in children by oral swab polymerase chain reaction

Nicol

Wood

Workman

et al. 2019

Sci Rep

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Microbiological diagnosis of pediatric pulmonary tuberculosis (TB) is challenging due to the difficulty of collecting and testing sputum from children. We investigated whether easily-obtained oral swab samples are useful alternatives or supplements to sputum. oral swabs and induced sputum (Is) were collected from 201 South African children with suspected pulmonary TB. IS samples were tested by mycobacterial culture and Xpert MTB/RIF. Oral swabs were tested by PCR targeting IS6110. Children were categorized as Confirmed TB (microbiologic confirmation on IS), Unconfirmed TB (clinical diagnosis only), or Unlikely TB (recovery without TB treatment). Relative to Confirmed TB, PCR on two oral swabs per child was 43% sensitive and 93% specific. This sensitivity fell below that of sputum Xpert (64%). Among children with either Confirmed or Unconfirmed TB, PCR on two oral swabs per child was 31% sensitive and 93% specific, which was more sensitive than sputum testing among this group (21%). Although oral swab analysis had low sensitivity in sputum-positive children, it detected TB in a significant proportion of sputum-negative children who were clinically diagnosed with TB. Specificity at 93% was suboptimal but may improve with the use of automated methods. With further development, oral swabs may become useful supplements to sputum as samples for diagnosis of pulmonary tB in children.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Microbiological diagnosis of pulmonary tuberculosis in children by oral swab polymerase chain reaction

Nicol

Wood

Workman

et al. 2019

Sci Rep

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“…The next-generation Xpert MTB/RIF Ultra assay has improved sensitivity (199), but its ability to detect subclinical TB is unknown and still requires a sputum sample for the diagnosis of pulmonary TB. Several non-sputumbased approaches are currently under development for diagnosing active TB in both adults and children, which include M. tuberculosis nucleic acid detection in oral mucosa and stool (200,201) as well the as detection of M. tuberculosis proteins and metabolites in urine (202). The most developed non-sputum-based assay detects urinary lipoarabinomannan (LAM) (203) and is indicated for use in severely immunocompromised HIV-infected hospitalized patients (204).…”

Section: Current Approaches and Incremental Improvements For Subclinimentioning

confidence: 99%

Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection

et al. 2018

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SUMMARYTuberculosis (TB) is the leading infectious cause of mortality worldwide, due in part to a limited understanding of its clinical pathogenic spectrum of infection and disease. Historically, scientific research, diagnostic testing, and drug treatment have focused on addressing one of two disease states: latent TB infection or active TB disease. Recent research has clearly demonstrated that human TB infection, from latent infection to active disease, exists within a continuous spectrum of metabolic bacterial activity and antagonistic immunological responses. This revised understanding leads us to propose two additional clinical states: incipient and subclinical TB. The recognition of incipient and subclinical TB, which helps divide latent and active TB along the clinical disease spectrum, provides opportunities for the development of diagnostic and therapeutic interventions to prevent progression to active TB disease and transmission of TB bacilli. In this report, we review the current understanding of the pathogenesis, immunology, clinical epidemiology, diagnosis, treatment, and prevention of both incipient and subclinical TB, two emerging clinical states of an ancient bacterium.

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“…Other non-respiratory specimens have been tested using Xpert MTB/RIF in children. Previous studies have shown that stool Xpert has similar performance as gastric aspirate in HIVinfected children (LaCourse et al, 2018) and in those with severe pulmonary disease (Walters et al, 2017), however, processing of stool samples is tedious and may not be readily done in peripheral laboratories.…”

Section: Discussionmentioning

confidence: 99%

Urine Xpert MTB/RIF for the diagnosis of childhood tuberculosis

Lopez

Aldaba

Morales-Dizon

et al. 2019

International Journal of Infectious Diseases

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Introduction: Xpert MTB/RIF is recommended for the simultaneous detection of tuberculosis (TB) and rifampicin resistance directly from sputum specimens. Since young children cannot always expectorate, we assessed urine as a possible specimen source to diagnose TB in children using Xpert MTB/RIF. Methods: During a field study to enhance childhood TB identification, spot urine samples were prospectively collected from consecutive ambulatory children aged 0 to 14 years presenting with presumptive pulmonary TB in community health centers. Urine Xpert MTB/RIF was performed by blinded technicians in 182 samples using 2 ml of unprocessed urine. Results: The mean age of presumptive TB cases was 5.9 years (median 5.4, range 0.1 to 14.7) with more males (113, 62%) compared to females. All urine samples tested negative for Xpert MTB/RIF, regardless of whether concentration was performed or not. Out of these 182 presumptive TB cases, 50 (28%) were clinically diagnosed and 5 (3%) were bacteriologically diagnosed to have TB disease using either sputum or nasopharyngeal aspirate specimens. Conclusions: In this community-based study, urine Xpert MTB/RIF does not appear to contribute to the diagnosis of childhood TB.

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Stool Xpert MTB/RIF and urine lipoarabinomannan for the diagnosis of tuberculosis in hospitalized HIV-infected children

Cited by 64 publications

References 34 publications

Microbiological diagnosis of pulmonary tuberculosis in children by oral swab polymerase chain reaction

Microbiological diagnosis of pulmonary tuberculosis in children by oral swab polymerase chain reaction

Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection

Urine Xpert MTB/RIF for the diagnosis of childhood tuberculosis

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