The utility of stool cultures for diagnosing tuberculosis in people living with the human immunodeficiency virus

Abstract

SUMMARY BACKGROUND Delayed diagnosis of tuberculosis (TB) increases mortality. OBJECTIVE To evaluate whether stool culture improves the diagnosis of TB in people living with the human immunodeficiency virus (PLHIV). DESIGN We analysed cross-sectional data of TB diagnosis in PLHIV in Cambodia, Thailand and Viet Nam. Logistic regression was used to assess the association between positive stool culture and TB, and to calculate the incremental yield of stool culture. RESULTS A total of 1693 PLHIV were enrolled with a stool culture result. Of 228 PLHIV with culture-confirmed TB from any site, 101 (44%) had a positive stool culture; of these, 91 (90%) had pulmonary TB (PTB). After adjusting for confounding factors, a positive stool culture was associated with smear-negative (odds ratio [OR] 26, 95% confidence interval [CI] 12–58), moderately smear-positive (OR 60, 95%CI 23–159) and highly smear-positive (OR 179, 95%CI 59–546) PTB compared with no PTB. No statistically significant association existed with extrapulmonary TB compared with no extrapulmonary TB (OR 2, 95%CI 1–5). The incremental yield of one stool culture above two sputum cultures (5%, 95%CI 3–8) was comparable to an additional sputum culture (7%, 95%CI 4–11). CONCLUSION Nearly half of the PLHIV with TB had a positive stool culture that was strongly associated with PTB. Stool cultures may be used to diagnose TB in PLHIV.

Detection of Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary tuberculosis

“…Though, routine culturing of feces for PTB detection was ineffective like sputum, the diagnosis of three participants (2.6%) for whom stool culture positive unlike sputum culture for PTB indicated that, if available, stool cultures may increase the number positive TB cases of PLHIV. This value must be counterbalanced against the increased processing requirements and higher culture contamination rates associated with culturing stool as also indicated by Oramasionwu et al [39]. Our finding was slightly higher than study by Khe´chine et al [40], in which MTC successfully grew in 9.7% of fecal sample from 134 patients suspected to be suffering PTB using the conventional solid culturing methods.…”

Assessing the impact of multidrug-resistant tuberculosis in children: an exploratory qualitative study

“…More generally, recent studies have documented an increase in MDR-TB in South Africa, including an increase in confirmed disease among children [10, 11]. Health outcomes for these children are variable: a 2011 study indicated that 53% of 968 South African children and adolescents with drug-resistant TB were cured or completed treatment, while 24% died [12]. However, other reports show more than 90% cure or treatment completion [13].…”

Molecular Diagnosis of TB in the HIV Positive Population

“…The stool heteroduplex PCR assay for RIF susceptibility had 98% agreement with sputum culture DST. Subsequently, a study of 1693 HIV-positive patients in southeast Asia revealed that 44% of those with culture-confirmed TB also had a positive stool culture, 67 and small pediatric studies detected TB in 47% to 75% of TB culture-positive children using Xpert MTB/RIF on stool samples. 68,69 Although the technical aspects of these nonsputum methods for detecting pulmonary and/or disseminated TB are still being developed, these methods hold the potential promise of easier specimen collection should they yield good results.…”