Use of Xpert MTB/RIF Ultra assay on stool and gastric aspirate samples to diagnose pulmonary tuberculosis in children in a high-tuberculosis-burden but resource-limited area of China

Sun, Lin; Yang, Lei; Fang, Min; Chen, Yú; Zhu, Yu; Xia, Cheng; Jia, Jihang; Quan, Shuting; Wang, Yacui; Tian, Xue; Shi, Yan; Duan, Lingxun; Shi, Xiongwei; Liao, Qiong; Wan, Chaomin; Shen, Adong

doi:10.1016/j.ijid.2021.11.012

Cited by 17 publications

(22 citation statements)

References 22 publications

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“…Samples other than GAs have also been evaluated, and stool is found to be a promising specimen [ 23 , 24 ]. Hence, the World Health Organization recommends stool as an alternative to sputum or GA for Xpert MTB/RIF in adults and children with suspected pulmonary TB [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

Venturini,

Bortone,

Cini

et al. 2023

Eur J Pediatr

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This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates. Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2–113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in sensitivity was significantly higher in children ≤ 4 years of age and in those with uncomplicated TB (p=0.008).Conclusions: Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern. What is known:• The diagnosis of paediatric tuberculosis is a challenge for paediatricians• Despite their low sensitivity gastric aspirates represent the standard sample for microbiological confirmation of active pulmonary tuberculosis in children• Most international guidelines recommend performing three sequential gastric aspirates on three consecutive days What is new:• A significant increase in global sensitivity by 13.4% was found by the collection of three gastric aspirates compared to the first one• Performing a higher number of gastric aspirates increases the sensitivity of microbiological confirmation, particularly in children ≤ 4 years and with an uncomplicated radiological pattern

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Section: Discussionmentioning

confidence: 99%

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

Venturini,

Bortone,

Cini

et al. 2023

Eur J Pediatr

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“…Different type of samples have been recently evaluated, as alternatives to the standard of care. In particular, preliminary data on the diagnostic yield of microbiological analysis on stools seems promising [23,24]. Moreover, few studies conducted in low-income settings evaluated the possibility to combine different samples type in order to increase the diagnostic yield in young children [25,26].…”

Section: Discussionmentioning

confidence: 99%

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

Venturini¹,

Bortone²,

Cini³

et al. 2022

Preprint

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Purpose This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates. Methods Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Results Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2–113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p = 0.014). Moreover, the increase in sensitivity was significantly higher in children ≤ 4 years of age and in those with uncomplicated TB (p = 0.008). Conclusion Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern.

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“…In conclusion, the study showed that Xpert Ultra on gastric aspirate samples had a diagnostic value for the early and accurate diagnosis of TB, especially in younger children ( Sun et al, 2020 ). More recently, the same authors analyzed the performance of Xpert Ultra on gastric aspirate specimens for the diagnosis of pediatric pulmonary TB in a high-burden area in China and reported an overall sensitivity of 52.5% and a sensitivity of 85.4% for 48 children with confirmed TB, concluding that gastric aspirate Xpert Ultra is an appropriate test for bacteriological TB confirmation in children ( Sun et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…A cross-sectional study on children aged <15 years from Bangladesh that assessed the performance of Xpert Ultra on stool to diagnose pulmonary TB in children reported a sensitivity of 83.3% (60 were positive out of 72 bacteriologically confirmed cases); a high proportion of Xpert Ultra positive assays had trace results ( Kabir et al, 2021 ). More recently, Sun et al (2021) analyzed the performance of Xpert Ultra on stool specimens for the diagnosis of pediatric pulmonary TB in a high-TB burden and resource-limited area in China, and reported an overall sensitivity of 60.3%. Among 48 children with confirmed TB, Xpert Ultra testing was equally sensitive on stool and gastric aspirate specimens (85.4%); however, the agreement between Xpert on stool and on gastric aspirate was moderate in children with active TB ( Sun et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…More recently, Sun et al (2021) analyzed the performance of Xpert Ultra on stool specimens for the diagnosis of pediatric pulmonary TB in a high-TB burden and resource-limited area in China, and reported an overall sensitivity of 60.3%. Among 48 children with confirmed TB, Xpert Ultra testing was equally sensitive on stool and gastric aspirate specimens (85.4%); however, the agreement between Xpert on stool and on gastric aspirate was moderate in children with active TB ( Sun et al, 2021 ). A prospective cohort study revealed a 45.5% sensitivity of Xpert Ultra using stool specimens for the diagnosis of pulmonary TB in children; moreover, the authors demonstrated that stool sample-based Xpert Ultra was a comparable alternative to M. tuberculosis culture on respiratory samples ( Liu et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Rapid Molecular Diagnosis of Extra-Pulmonary Tuberculosis by Xpert/RIF Ultra

Rindi

2022

Front. Microbiol.

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Rapid detection of Mycobacterium tuberculosis complex and determination of drug resistance are essential for early diagnosis and treatment of tuberculosis (TB). Xpert MTB/RIF Ultra (Xpert Ultra), a molecular test that can simultaneously identify M. tuberculosis complex and resistance to rifampicin directly on clinical samples, is currently used. Xpert Ultra represents a helpful tool for rapid pulmonary TB diagnosis, especially in patients with paucibacillary infection. The aim of this review is to provide an overview of the diagnostic performance of Xpert Ultra in detection of extra-pulmonary tuberculosis.

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Use of Xpert MTB/RIF Ultra assay on stool and gastric aspirate samples to diagnose pulmonary tuberculosis in children in a high-tuberculosis-burden but resource-limited area of China

Cited by 17 publications

References 22 publications

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

Rapid Molecular Diagnosis of Extra-Pulmonary Tuberculosis by Xpert/RIF Ultra

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