Diagnosing childhood pulmonary tuberculosis using a single sputum specimen on Xpert MTB/RIF at point of care

Gous, Natasha; Scott, Lesley; Khan, Sonjiha; Reubenson, Gary; Coovadia, Ashraf; Stevens, Wendy

doi:10.7196/samj.2015.v105i12.8585

Cited by 13 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Zar et al reported that Xpert MTB/RIF was a useful assay for the rapid and reliable diagnosis of paediatric TB in African children, using induced sputum and nasopharyngeal as the specimens ( 8 ). Gous et al also used the Xpert MTB/RIF assay to diagnose TB in childhood ( 9 ). Fiebig et al used the nucleic acid amplification tests and culture of gastric aspirates to detect bacteriological confirmation of TB in German children.…”

Section: Introductionmentioning

confidence: 99%

Identifying pathway modules of tuberculosis in children by analyzing multiple different networks

et al. 2017

View full text Add to dashboard Cite

Tuberculosis (TB), which is caused by the mycobacterium TB, is the major cause of human death worldwide. The aim of this study was to identify the biomarkers involved in child TB. Gene expression data were obtained from the Array Express Archive of Functional Genomics Data. Gene expression data and protein-protein interaction (PPI) data were downloaded to construct differential gene co-expression networks (DCNs). The Benjamini-Hochberg algorithm was used to correct the P-value. In total, 3,820 edges (PPIs) and 1,359 nodes (genes) were obtained from the human-related PPIs data and gene expression data at the criteria of absolute value of Pearson's correlation coefficient >0.8. The DCNs were formed by these edges and nodes. Thirteen seed genes were obtained by ranging z-scores. Eight significant multiple different modules were identified from DCNs using the statistical significant test. In conclusion, the seed genes and significant modules constitute potential biomarkers that reveal the underlying mechanisms in child TB. The new identified biomarkers may contribute to an understanding of TB and provide a new therapeutic method for the treatment of TB.

show abstract

Section: Introductionmentioning

confidence: 99%

Identifying pathway modules of tuberculosis in children by analyzing multiple different networks

et al. 2017

View full text Add to dashboard Cite

show abstract

“…After screening all the titles and abstracts, removing the duplicates and excluding the ineligible studies, 20 articles (5, 536 samples/patients) [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] were selected for full-text review and meta-analysis (Fig. 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eleven [44,47,48,52,54,56,57,58,60,62,63] reported detection of pulmonary TB (PTB), ten [44,45,46,49,50,51,53,55,59,61] reported detection of extra-pulmonary TB (EPTB) and one [44] reported on both types of clinical sample. Table 1 summarises the main characteristics of the included studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Paediatric Tuberculosis Diagnosis Using Mycobacterium Tuberculosis Real-time Polymerase Chain Reaction Assay: a Systematic Review and Meta-analysis

Babafemi

Cherian

Ouma

et al. 2021

Preprint

View full text Add to dashboard Cite

Background:Rapid and accurate diagnosis of paediatric tuberculosis (TB) is key to manage the disease and to control and prevent its transmission. Collection of quality sputum samples without invasion methods from paediatrics (age <16 years) with presumptive pulmonary tuberculosis (PTB) remains a challenge. Clinical management is especially challenging, and recommendations are based on restricted evidence. Many established diagnostic methods suffer from low sensitivity or delay of timely results and are inadequate for rapid detection of Mycobacterium tuberculosis (MTB) in pulmonary and extra-pulmonary clinical samples. This study assessed the overall accuracy of a real-time polymerase chain reaction (RT-PCR) based assay, with a turn-a-round time of 2 h, for routine diagnosis of MTB in different samples from paediatrics with active pulmonary and extra-pulmonary tuberculosis using mycobacterial culture as the gold standard in clinical microbiology laboratories.Methods:We conducted a systematic review and meta-analysis to examine the diagnostic accuracy of RT-PCR based assay for the detection of MTB in paediatric clinical samples. A systematic literature search was performed for publications in any language. The following sources were used MEDLINE via PubMed, EMBASE, BIOSIS Citation Index, Web of Science, SCOPUS, ISI Web of Knowledge, World Health Organization and Centres for Disease Control and Prevention websites, Cochrane Infectious Diseases Group Specialised Register, and grey literature. Twenty studies (5,536 specimens) that met set inclusion criteria were included. Bivariate random-effects model of meta-analysis were performed to generate pooled summary estimates (95% CIs) for overall accuracy of RT-PCR based assay compared to mycobacterial culture as the reference standard. Results:Of the 1592 candidate studies, twenty eligible studies met our inclusion criteria. In total, the review and meta-analysis included 5, 536 (3, 209 PTB and 2, 327 EPTB). Summary estimates for pulmonary TB (11 studies) were as follows: sensitivity 56 (95% CI 51-62), specificity 97 (95% CI 96-98), positive likelihood ratio 70.73 (95% CI 8.55-585.40), negative likelihood ratio 0.43 (0.28-0.66), diagnostic odds ratio 193.06 (95% CI 51.21- 727.83) and summary receiver operating characteristic (SROC) area under curve 0.98. Summary estimates for extra-pulmonary TB (10 studies) were as follows: sensitivity 87 (95% CI 82-91)) specificity 100 (95% CI 99-100), positive likelihood ratio 111.91(53.97-232.04), negative likelihood ratio 0.15 (0.07-0.30), diagnostic odds ratio 1337.84 (95% CI 441.92- 4050.12) and summary receiver operating characteristic (SROC) area under curve 0.99. There was significant heterogeneity in sensitivity and specificity among the enrolled studies (p< 0.001).Conclusions:Our results suggested that the RT-PCR based assay could be a useful test for the diagnosis of paediatrics TB with high sensitivity and specificity in low-income/high-burden and upper medium income/low-burden settings.RT-PCR assay demonstrated a high degree of sensitivity for extra-pulmonary TB and good sensitivity for pulmonary TB. It indicated a high degree of specificity for ruling in TB infection from sampling regimes. This was acceptable but may better as a rule out add-on diagnostic test. RT-PCR based assays demonstrate both a high degree of sensitivity in extra-pulmonary and moderate sensitivity in pulmonary samples and rapidity of detection of TB which is an important factor in achieving effective global control and for patient management in terms of initiating early and appropriate anti-tubercular therapy. Systematic review registration: PROSPERO CRD42018104052

show abstract

“…Although WHO recommends Xpert MTB/RIF testing for children, Xpert MTB/RIF (where available) was only used in 8% and culture in 17% cases [24]. Further, a study in Johannesburg showed 67% sputum collected from children <14yrs (median age 24months) was below the required volume for Xpert MTB/RIF testing [25]. Overall, this highlights the need for strengthening the capacity for diagnosis, proactive screening for TB and MDR-TB in in-patient settings and the community [26].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of opportunistic infections

Scott

Silva

Boehme

et al. 2017

Current Opinion in HIV and AIDS

Self Cite

View full text Add to dashboard Cite

Purpose of the review TB incidence has declined ~1.5% annually since 2000, but continued to affect 10.4 million individuals in 2015, with 1/3 remaining undiagnosed or under reported. The diagnosis of TB among those co-infected with HIV is challenging as TB remains the leading cause of death in such individuals. Accurate and rapid diagnosis of active TB will avert mortality in both adults and children, reduce transmission, and assist in timeous decisions for ART initiation. This review describes advances in diagnosing TB, especially among HIV co-infected individuals, highlights national program’s uptake, and impact on patient care. Recent Findings The TB diagnostic landscape has been transformed over the last 5 years. Molecular diagnostics such as Xpert MTB/RIF, which simultaneously detects M. tuberculosis resistance to rifampicin, has revolutionised TB control programs. WHO endorsed the use of Xpert MTB/RIF in 2010 for use in HIV/TB co-infected patients, and later in 2013 for use as the initial diagnostic test for all adults and children with signs and symptoms of pulmonary TB. Line probe assays (LPAs) are recommended for the detection of rifampicin and isoniazid resistance in sputum smear-positive specimens and mycobacterial cultures. A second-line line probe assay has been recommended for the diagnosis of extensively drug-resistant (XDR)-TB Assays such as the urine lateral flow(LF)-lipoarabinomannan(LAM), can be used at the point of care (POC) and have a niche role to supplement the diagnosis of TB in seriously ill HIV infected, hospitalized patients with low CD4<100cells/μl. Polyvalent platforms such as the m2000 (Abbott Molecular, IL, USA) and GeneXpert (Cepheid, CA, USA) offer potential for integration of HIV and TB testing services. While the Research and Development (R&D) pipeline appears to be rich at first glance, there are actually few leads for true POC tests that would allow for earlier TB diagnosis or rapid, comprehensive drug susceptibility testing, especially when considering the very high attrition rates observed between biomarker discovery and product market entry. Summary In this review, we describe diagnostic strategies specifically for HIV and TB co-infected individuals. Molecular diagnostics in particular within the past 5 years have revolutionized and “disrupted” this field. They lend themselves to integration of services with platforms capable of polyvalent testing. Impact on patient care is, however, still debatable. What has been highlighted is the need for health system strengthening and for true POC testing that can be used in active case finding.

show abstract

Diagnosing childhood pulmonary tuberculosis using a single sputum specimen on Xpert MTB/RIF at point of care

Cited by 13 publications

References 19 publications

Identifying pathway modules of tuberculosis in children by analyzing multiple different networks

Identifying pathway modules of tuberculosis in children by analyzing multiple different networks

Paediatric Tuberculosis Diagnosis Using Mycobacterium Tuberculosis Real-time Polymerase Chain Reaction Assay: a Systematic Review and Meta-analysis

Diagnosis of opportunistic infections

Contact Info

Product

Resources

About