Detection of Mycobacterium tuberculosis (MTB) in Fecal Specimens From Adults Diagnosed With Pulmonary Tuberculosis Using the Xpert MTB/Rifampicin Test

Kokuto, Hiroyuki; Sasaki, Yuka; Yoshimatsu, Shoji; Mizuno, Kazue; Liu, Yi; Mitarai, Satoshi

doi:10.1093/ofid/ofv074

Cited by 29 publications

(28 citation statements)

References 16 publications

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“…A recent meta-analysis of stool Xpert for children showed pooled sensitivity and specificity of 67% and 99%, respectively 12 . Although data on molecular testing of stool for adults is limited, high sensitivity and specificity is reported with stool PCR and stool Xpert in PTB patients 8,13,14 . In a run with limited samples, our results on stool Xpert also showed high accuracy (83.3%) for PTB but tested positive for only 2/12 EPTB patient samples.…”

Section: Discussionmentioning

confidence: 99%

“…Culture identification also has limited role in routine diagnosis in India and is recommended for screening of drug-resistance 5,6 . Many recent studies have tested efficacy of stool in molecular diagnosis of pediatric PTB, while scarce reports are available on adult stool testing for detection of PTB from other countries [7][8][9][10][11][12][13][14][15][16] .…”

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confidence: 99%

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Diagnostic performance of non-invasive, stool-based molecular assays in patients with paucibacillary tuberculosis

Gaur

Singh

Sharma

et al. 2020

Sci Rep

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timely diagnosis of paucibacillary tuberculosis (tB) which includes smear-negative pulmonary tB (ptB) and extra-pulmonary tB (eptB) remains a challenge. this study was performed to assess the diagnostic utility of stool as a specimen of choice for detection of mycobacterial DnA in paucibacillary TB patients in a TB-endemic setting. Stool samples were collected from 246 subjects including 129 TB patients (62 PTB and 67 EPTB) recruited at TB hospital in Delhi, India. Diagnostic efficacy of stool IS6110 PCR (n = 228) was measured, using microbiologically/clinically confirmed TB as the reference standard. The clinical sensitivity of stool PCR was 97.22% (95% confidence interval (CI), 85.47-99.93) for detection of Mycobacterium tuberculosis in stool samples of smear-positive PTB patients and 76.92% (CI, 56.35-91.03) in samples from smear-negative PTB patients. Overall sensitivity of PCR for EPTB was 68.66% (CI, 56.16-79.44), with the highest sensitivity for stool samples from patients with lymph node TB (73.5%), followed by abdominal TB (66.7%) and pleural effusion (56.3%). Stool PCR presented a specificity of 95.12%. The receiver operating characteristic curve also indicated the diagnostic utility of stool PCR in TB detection (AUC: 0.882). The performance characteristic of the molecular assay suggests that stool DnA testing has clinical value in detection of tB.Tuberculosis (TB), a global health problem, is caused by Mycobacterium tuberculosis (Mtb) and has two ways of clinical manifestation. Apart from the common pulmonary TB (PTB) manifestation, extrapulmonary TB (EPTB) is identified as a major concern and contributes significantly to the disease burden worldwide. According to the World Health Organization (WHO), 10 million people fell ill with TB in 2018 1 . Although new strategies for diagnosis and treatment over the past decade have led to decline in death rate, it remains inadequate to reach the milestone of the WHO "End-TB" goal 1 . Apart from the diagnostic and treatment difficulties faced in the eradication of PTB, timely diagnosis and treatment of EPTB is considered a bigger challenge. This is due to the diverse, non-specific and paucibacillary presentation of EPTB at remote body sites and requirement of a longer treatment regimen 2 . In 2018, an increase in EPTB incidence was reported in India 3 , which is also considered as a TB high-burden country by the WHO. A probable explanation for this rise can be in part due to access to better diagnostic tools that highlight the fact that EPTB burden may have been underrepresented over the years. Thus, accurate and rapid diagnostic tests for PTB and EPTB are key to limit the spread of the epidemic.In India, diagnosis of TB is done by the Revised National Tuberculosis Control Program guidelines that follow the WHO recommendations ( Fig. 1). At present, although the diagnosis of PTB by sputum-smear direct microscopy is considerably established, the diagnosis of smear-negative PTB and EPTB poses serious challenges due to paucibacillary nature of the specimen. Diagnos...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Diagnostic performance of non-invasive, stool-based molecular assays in patients with paucibacillary tuberculosis

Gaur

Singh

Sharma

et al. 2020

Sci Rep

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“…Emerging evidence suggests that using larger sample volumes, of 0.6 g25 and 2 cm 3 ,26 and pre-treatment with a stool-processing buffer to inactivate PCR inhibitors,25 achieves greater diagnostic yield of the stool Xpert test.…”

Section: Discussionmentioning

confidence: 99%

Stool Xpert^® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe

Chipinduro

Mateveke

Makamure

et al. 2017

int j tuberc lung dis

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SUMMARYOBJECTIVE: To evaluate the diagnostic performance of Xpert® MTB/RIF on stool samples from children with clinical suspicion of pulmonary tuberculosis (PTB) at primary care clinics.DESIGN: A cross-sectional diagnostic evaluation enrolling 5–16 year olds from whom one induced sputum (IS) sample was tested for microbiological TB confirmation. Results of a single stool sample tested using Xpert were compared against microbiologically confirmed TB, defined as a positive result on sputum microscopy and/or culture and/or IS Xpert.RESULTS: Of 222 children enrolled, 218 had complete microbiological results. The median age was 10.6 years (interquartile range 8–13). TB was microbiologically confirmed in 19/218 (8.7%) children. Of these, respectively 5 (26%), 9 (47%) and 15 (79%) were smear-, culture- and IS Xpert-positive. Stool Xpert was positive in 13/19 (68%) microbiologically confirmed cases and 4/199 (2%) microbiologically negative cases. Stool Xpert detected 76.9% (10/13) of human immunodeficiency virus (HIV) infected and 50% (3/6) of non-HIV-infected children with microbiologically confirmed TB (P = 0.241).CONCLUSION: Stool Xpert is a potential alternative screening test for children with suspected TB if sputum is unavailable. Strategies to optimise the diagnostic yield of stool Xpert assay need further study.

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“…In recent years, enormous effort has been paid in applying techniques of nucleic acid 2 , proteomics 3 4 and immunological biomarkers 5 for diagnosis of tuberculosis. Among these, Xpert MTB/RIF (Cepheid, Sunnyvale, California), which is based on nucleic acid amplification, attracts considerable attention due to its fast and specific results for tuberculosis diagnosis and concomitant identification of rifampicin resistance, but its efficacy for those patients without sputum or AFB (acid fast bacilli) smear-negative was limited 4 6 7 8 . Mycobacterium tuberculosis ( Mtb )-specific IFN-γ Release assays (IGRAs) by peripheral blood constitute an increasingly widely applied route 9 10 and has been recognized as the most important advancement in immunodiagnosis of TB in the last decade.…”

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Discriminating Active Tuberculosis from Latent Tuberculosis Infection by flow cytometric measurement of CD161-expressing T cells

Yang

Chen

et al. 2015

Sci Rep

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Interferon-gamma Release Assays (IGRAs) significantly increases the possibility for early diagnosis of tuberculosis, but IGRAs alone cannot discriminate active TB from LTBI. Therefore, fast and reliable discrimination of active tuberculosis, especially bacteriology negative tuberculosis, from LTBI is a great necessity. Here we established an assay based on flow cytometric multiparameter assay assessing expression of CD161 along with CD3, CD4, and CD8, whereby a set of indices formulated by the percentages of CD3+CD161+, CD3+CD4+CD161+ and CD3+CD8+CD161+ T cells multiplied with lymphocyte/monocyte ratio were established. Application of the CD3+CD8+CD161+ index to compare a cohort of active tuberculosis with a cohort of LTBI or health control yielded 0.7662 (95% confidence interval [CI] 0.6559–0.8552) or 0.7922 (95% CI 0.6846–0.8763) for sensitivity and 0.9048 (95% CI 0.8209–0.9580) or 0.8939 (95% CI 0.8392–0.9349) for specificity when the TB cohort was AFB+; the corresponding results were 0.7481 (95% CI 0.6648–0.8198) or 0.7557 (95% CI 0.6730–0.8265) for sensitivity and 0.8571 (95% CI 0.7637–0.9239) or 0.8603 (95% CI 0.8008–0.9075) for specificity when the TB cohort was AFB−. Our results reveal that in combination with IGRAs, CD161-based indices provide a novel, fast diagnostic solution addressing the limitation of current tuberculosis diagnostics.

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Detection of Mycobacterium tuberculosis (MTB) in Fecal Specimens From Adults Diagnosed With Pulmonary Tuberculosis Using the Xpert MTB/Rifampicin Test

Abstract: We performed a proof-of-concept study using the Xpert MTB/RIF test for the detection of Mycobacterium tuberculosis from fecal samples. The overall sensitivity was 85.7% (95% CI; 73.8 – 93.6%) and the specificity was 100% (95% CI; 86.2–100).

Cited by 29 publications

References 16 publications

Diagnostic performance of non-invasive, stool-based molecular assays in patients with paucibacillary tuberculosis

Diagnostic performance of non-invasive, stool-based molecular assays in patients with paucibacillary tuberculosis

Stool Xpert^® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe

Discriminating Active Tuberculosis from Latent Tuberculosis Infection by flow cytometric measurement of CD161-expressing T cells

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Detection of Mycobacterium tuberculosis (MTB) in Fecal Specimens From Adults Diagnosed With Pulmonary Tuberculosis Using the Xpert MTB/Rifampicin Test

Abstract: We performed a proof-of-concept study using the Xpert MTB/RIF test for the detection of Mycobacterium tuberculosis from fecal samples. The overall sensitivity was 85.7% (95% CI; 73.8 – 93.6%) and the specificity was 100% (95% CI; 86.2–100).

Cited by 29 publications

References 16 publications

Diagnostic performance of non-invasive, stool-based molecular assays in patients with paucibacillary tuberculosis

Diagnostic performance of non-invasive, stool-based molecular assays in patients with paucibacillary tuberculosis

Stool Xpert® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe

Discriminating Active Tuberculosis from Latent Tuberculosis Infection by flow cytometric measurement of CD161-expressing T cells

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About

Stool Xpert^® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe