The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers

Abstract

Introduction: The diagnostic accuracy of Xpert MTB/RIF (Xpert) in pulmonary tuberculosis (PTB) in children is lower than in adults. In Brazil, the diagnosis of PTB is based on a diagnostic score system (DSS). This study aims to study the role of Xpert in children and adolescents with PTB symptoms. Methods: A cross-sectional study was conducted in 3 referral centers to TB. Children and adolescents (0-19 years old) whose respiratory samples were submitted to Xpert were included. Statistical analysis (bivariate and logistic regression) to assess the simultaneous influence of TB-related variables on the occurrence of Xpert detectable in TB cases was done. To evaluate the agreement or disagreement between Xpert results with acid-fast bacillus (AFB) and cultures, κ method was used (significancy level of 5%). Results: Eighty-eight patients were included in the study and PTB occurred in 43 patients (49%) and Xpert was detectable in 21 patients (24%). Adolescents and positive culture results were independent predictive variables of Xpert positivity. DSS sensitivity compared with the final diagnosis of TB was 100% (95% CI, 88.1-100%), specificity was 97.2% (95% CI, 85.5-99.9%). The accuracy of the method was 98.5% (95% CI, 91.7-99.9%). Conclusions: Xpert contributed to diagnosis in 9% of patients with AFB and in culture negative cases. DSS indicated relevance for this diagnostic approach of intrathoracic TB (ITB) in reference centers for presenting data both with high sensitivity and specificity.

Directrices unificadas de la OMS sobre la tuberculosis. Módulo 5: Manejo de la tuberculosis en la población infantil y adolescente

“…Con el objeto de hacer pleno uso de los datos disponibles para comparar el rendimiento de estos algoritmos en diferentes configuraciones, se imputaron las variables faltantes, se colapsaron las definiciones heterogéneas de variables y se introdujeron ligeras modificaciones en los algoritmos o puntuaciones para permitir el uso de las variables disponibles en el conjunto de datos de participantes individuales. Se incluyeron 14 estudios, que comprendían 5494 registros, de los cuales 4811 se incorporaron en este análisis (26,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Se incluyeron estudios de 13 países (entre ellos 12 países con carga alta de TB, TB/VIH o TB-MDR) de cinco de las seis regiones de la OMS.…”

Diagnosis of tuberculosis: a consensus statement from the Brazilian Thoracic Association

“…The difficulties in diagnosis, contact tracing, and access to health care facilities would explain this challenge from a public health standpoint. 7 , 42 …”

“…Studies have addressed malnutrition as either a cause or a consequence of tuberculosis, depending on the epidemiological scenario in question. 42 …”

“…However, the rate of rifampin resistance among only the patients with an RMT-TB result of “ M. tuberculosis detected” was 17%, which is similar to that reported in the literature. 42 In 2017, the WHO started to recommend the use of Xpert Ultra, which is more sensitive than its predecessor, with good prospects for use in paucibacillary cases, such as in children and individuals living with HIV/AIDS. 49 …”

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

“…In recent years, molecular diagnostic techniques have become widely used in the diagnosis and epidemiological investigation of infection by bacteria of the mycobacterium tuberculosis complex (MTBC). ( Carpentier et al., 1995 ; Detjen et al., 2015 ; Aurilio et al., 2020 ) The Xpert MTB/RIF method is recommended by the WHO for rapid diagnosis of TB, replacing the traditional time-consuming culture method.…”