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Moretó-Planas L, Mahajan R, Fidelle Nyikayo L, Ajack YBP, Tut Chol B, Osman E, Sangma M, Tobi A, Gallo J, Biague E, Gonçalves R, Rocaspana M, Medina C, Camará M, Flevaud L, Ruby LC, Bélard S, Sagrado MJ, Molina I, Llosa AE. Xpert-Ultra Assay in Stool and Urine Samples to Improve Tuberculosis Diagnosis in Children: The Médecins Sans Frontières Experience in Guinea-Bissau and South Sudan. Open Forum Infect Dis 2024; 11:ofae221. [PMID: 38798893 PMCID: PMC11119760 DOI: 10.1093/ofid/ofae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Background More than half of childhood tuberculosis cases remain undiagnosed yearly. The World Health Organization recommends the Xpert-Ultra assay as a first pediatric diagnosis test, but microbiological confirmation remains low. We aimed to determine the diagnostic performance of Xpert-Ultra with stool and urine samples in presumptive pediatric tuberculosis cases in 2 high-tuberculosis-burden settings. Methods This Médecins Sans Frontières cross-sectional multicentric study took place at Simão Mendes Hospital, Guinea-Bissau (July 2019 to April 2020) and in Malakal Hospital, South Sudan (April 2021 to June 2023). Children aged 6 months to 15 years with presumptive tuberculosis underwent clinical and laboratory assessment, with 1 respiratory and/or extrapulmonary sample (reference standard [RS]), 1 stool, and 1 urine specimen analyzed with Xpert-Ultra. Results A total of 563 children were enrolled in the study, 133 from Bissau and 400 from Malakal; 30 were excluded. Confirmation of tuberculosis was achieved in 75 (14.1%), while 248 (46.5%) had unconfirmed tuberculosis. Of 553 with an RS specimen, the overall diagnostic yield was 12.4% (66 of 533). A total of 493 stool and 524 urine samples were used to evaluate the performance of Xpert-Ultra with these samples. Compared with the RS, the sensitivity and specificity of Xpert-Ultra were 62.5% (95% confidence interval, 49.4%-74%) and 98.3% (96.7%-99.2%), respectively, with stool samples, and 13.9% (7.5%-24.3%) and 99.4% (98.1%-99.8%) with urine samples. Nine patients were positive with stool and/or urine samples but negative with the RS. Conclusions Xpert-Ultra in stool samples showed moderate to high sensitivity and high specificity compared with the RS and an added diagnostic yield when RS results were negative. Xpert-Ultra in stool samples was useful in extrapulmonary cases. Xpert-Ultra in urine samples showed low test performance. Clinical Trials Registration NCT06239337.
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Affiliation(s)
- Laura Moretó-Planas
- Medecins Sans Frontières, Medical Department, Barcelona, Spain
- Autonomous University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | | | | | | | - Buai Tut Chol
- Medecins Sans Frontières, Juba, Republic of South Sudan
| | | | | | - Apal Tobi
- National Tuberculosis Program, Ministry of Health, Juba, Republic of South Sudan
| | | | | | | | - Mercè Rocaspana
- Medecins Sans Frontières, Medical Department, Barcelona, Spain
| | | | - Miguel Camará
- National Tuberculosis Program, Ministry of Health, Bissau, Guinea-Bissau
| | | | - Lisa C Ruby
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Sabine Bélard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | | | - Israel Molina
- Infectious Disease Department, Vall d’Hebron Hospital, Barcelona, Spain
| | - Augusto E Llosa
- Medecins Sans Frontières, Medical Department, Barcelona, Spain
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Yu X, Wang F, Ren R, Dong L, Xue Y, Zhao L, Jia J, Huang H. Xpert MTB/RIF Ultra Assay Using Stool: an Effective Solution for Bacilli Identification from Adult Pulmonary Tuberculosis Suspects without Expectorated Sputum. Microbiol Spectr 2023; 11:e0126523. [PMID: 37378554 PMCID: PMC10434112 DOI: 10.1128/spectrum.01265-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
This study evaluated the diagnostic performance of stool-based Xpert MTB/RIF Ultra assay (Xpert-Ultra, Cepheid, USA) against other tests using respiratory tract specimens (RTS) and stool for diagnosing adult pulmonary tuberculosis. A prospective study on patients with presumptive pulmonary tuberculosis was conducted in Beijing Chest Hospital from June to November 2021. The smear test, MGIT960 liquid culture, and Xpert MTB/RIF (Xpert, Cepheid, USA) were performed simultaneously on RTS, and smear, culture Xpert, and Xpert-Ultra were performed simultaneously using stool. Patients were grouped based on the outcomes of RTS examination and other tests. In total, 130 eligible patients were enrolled that included 96 pulmonary tuberculosis and 34 non-TB patients. The sensitivity of smear, culture, Xpert, and Xpert-Ultra using stool was 10.96%, 23.28%, 60.27%, and 79.45%, respectively. The specificities of Xpert and Xpert-Ultra using RTS and stool were all 100% (34/34). Notably, all five confirmed cases detected by bronchoalveolar lavage fluid (BALF) examination yielded Xpert-Ultra positive outcomes with the stool specimens. Xpert-Ultra assay on stool sample harbors comparable sensitivity with Xpert on RTS. Thus, the Xpert-Ultra testing on stool specimens could be a very promising and practical strategy to improve pulmonary tuberculosis (PTB) diagnosis, especially among patients who could not expectorate sputum. IMPORTANCE This study is aimed at assessing the value of Xpert MTB/RIF Ultra (Xpert-Ultra) in PTB on stool in adult in low HIV settings and Xpert-Ultra assay on stool sample harboring comparable sensitivity with Xpert MTB/RIF on respiratory tract specimens. Although the yield in stool samples by Xpert-Ultra is lower than RTS, it may be useful in detecting disease in presumptive TB patients who cannot expectorate sputum and are not open to BALF collection. In addition, Xpert-Ultra with a "trace call" on stool in adult was highly supportive of PTB.
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Affiliation(s)
- Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Fen Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Ruyan Ren
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Lingling Dong
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Yi Xue
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Liping Zhao
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Junnan Jia
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, Beijing, China
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Olbrich L, Nliwasa M, Sabi I, Ntinginya NE, Khosa C, Banze D, Corbett EL, Semphere R, Verghese VP, Michael JS, Graham SM, Egere U, Schaaf HS, Morrison J, McHugh TD, Song R, Nabeta P, Trollip A, Geldmacher C, Hoelscher M, Zar HJ, Heinrich N. Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease: A Diagnostic Accuracy Study for Pediatric Tuberculosis. Pediatr Infect Dis J 2023; 42:353-360. [PMID: 36854097 PMCID: PMC10097493 DOI: 10.1097/inf.0000000000003853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study. METHODS This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor's and all relevant local ethics committees. DISCUSSION As a diagnostic accuracy study for a disease with an imperfect reference standard, Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB) was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB.
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Affiliation(s)
- Laura Olbrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Marriott Nliwasa
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Issa Sabi
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Nyanda E. Ntinginya
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Denise Banze
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robina Semphere
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Valsan P. Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College (CMC), Vellore, India
| | - Joy Sarojini Michael
- Department of Clinical Microbiology, Christian Medical College (CMC), Vellore, India
| | - Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics, Royal Children’s Hospital, Melbourne, Australia
| | - Uzochukwu Egere
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - H. Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Julie Morrison
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College, London, London, United Kingdom
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Pamela Nabeta
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Andre Trollip
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Christof Geldmacher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Hoelscher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Heather J. Zar
- Department of Paediatrics & Child Health, SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Norbert Heinrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
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Marcy O, Wobudeya E, Font H, Vessière A, Chabala C, Khosa C, Taguebue JV, Moh R, Mwanga-Amumpaire J, Lounnas M, Mulenga V, Mavale S, Chilundo J, Rego D, Nduna B, Shankalala P, Chirwa U, De Lauzanne A, Dim B, Tiogouo Ngouana E, Folquet Amorrissani M, Cisse L, Amon Tanoh Dick F, Komena EA, Kwedi Nolna S, Businge G, Natukunda N, Cumbe S, Mbekeka P, Kim A, Kheang C, Pol S, Maleche-Obimbo E, Seddon JA, Mao TE, Graham SM, Delacourt C, Borand L, Bonnet M. Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:341-351. [PMID: 36395782 DOI: 10.1016/s1473-3099(22)00668-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. METHODS We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). FINDINGS From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial. INTERPRETATION Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition. FUNDING Unitaid and L'Initiative. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Olivier Marcy
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France.
| | - Eric Wobudeya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Hélène Font
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France
| | - Aurélia Vessière
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France
| | - Chishala Chabala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Raoul Moh
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | - Manon Lounnas
- MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Veronica Mulenga
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Sandra Mavale
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Josina Chilundo
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Dalila Rego
- Paediatrics Department, José Macamo General Hospital, Maputo, Mozambique
| | | | - Perfect Shankalala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Uzima Chirwa
- Children's Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Agathe De Lauzanne
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bunnet Dim
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | - Lassina Cisse
- Paediatrics Department, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire
| | | | - Eric A Komena
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Sylvie Kwedi Nolna
- IRD UMI233, Inserm U1175, University of Montpellier, Montpellier, France
| | - Gerald Businge
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | | | - Ang Kim
- Pulmonology Department, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Chanrithea Kheang
- Paediatrics Department, Kompong Cham Provincial Hospital, Kompong Cham, Cambodia
| | - Sokha Pol
- Paediatrics Department, Takeo Provincial Hospital, Takeo, Cambodia
| | | | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy, Ministry of Health, Phnom Penh, Cambodia
| | - Stephen M Graham
- University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France; Burnet Institute, Melbourne, VIC, Australia
| | - Christophe Delacourt
- Department of Paediatric Pulmonology, Necker University Teaching Hospital, Paris, France
| | - Laurence Borand
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Maryline Bonnet
- IRD UMI233, Inserm U1175, University of Montpellier, Montpellier, France
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Farina E, D'Amore C, Lancella L, Boccuzzi E, Ciofi Degli Atti ML, Reale A, Rossi P, Villani A, Raponi M, Raucci U. Alert sign and symptoms for the early diagnosis of pulmonary tuberculosis: analysis of patients followed by a tertiary pediatric hospital. Ital J Pediatr 2022; 48:90. [PMID: 35698090 PMCID: PMC9195307 DOI: 10.1186/s13052-022-01288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intercepting earlier suspected TB (Tuberculosis) cases clinically is necessary to reduce TB incidence, so we described signs and symptoms of retrospective cases of pulmonary TB and tried to evaluate which could be early warning signs. Methods We conducted a retrospective descriptive study of pulmonary TB cases in children in years 2005–2017; in years 2018–2020 we conducted a cohort prospective study enrolling patients < 18 years accessed to Emergency Department (ED) with signs/symptoms suggestive of pulmonary TB. Results In the retrospective analysis, 226 patients with pulmonary TB were studied. The most frequently described items were contact history (53.5%) and having parents from countries at risk (60.2%). Cough was referred in 49.5% of patients at onset, fever in 46%; these symptoms were persistent (lasting ≥ 10 days) in about 20%. Lymphadenopathy is described in 15.9%. The prospective study enrolled 85 patients of whom 14 (16.5%) were confirmed to be TB patients and 71 (83.5%) were non-TB cases. Lymphadenopathy and contact history were the most correlated variables. Fever and cough lasting ≥ 10 days were less frequently described in TB cases compared to non-TB patients (p < 0.05). Conclusions In low TB endemic countries, pulmonary TB at onset is characterized by different symptoms, i.e. persistent fever and cough are less described, while more relevant are contact history and lymphadenopathy. It was not possible to create a score because signs/symptoms usually suggestive of pulmonary TB (considered in the questionnaire) were not significant risk factors in our reality, a low TB country. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01288-5.
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Affiliation(s)
- Elisa Farina
- Unit of Internal Medicine, Celio Military Hospital, Rome, Italy
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Division of Immunology and Infectious Diseases, Department (DPUO), University-Hospital Pediatric, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Elena Boccuzzi
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Antonino Reale
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Rossi
- Medical Direction, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Umberto Raucci
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Diagnostic Advances in Childhood Tuberculosis—Improving Specimen Collection and Yield of Microbiological Diagnosis for Intrathoracic Tuberculosis. Pathogens 2022; 11:pathogens11040389. [PMID: 35456064 PMCID: PMC9025862 DOI: 10.3390/pathogens11040389] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 01/26/2023] Open
Abstract
There is no microbiological gold standard for childhood tuberculosis (TB) diagnosis. The paucibacillary nature of the disease, challenges in sample collection in young children, and the limitations of currently available microbiological tests restrict microbiological confirmation of intrathoracic TB to the minority of children. Recent WHO guidelines recommend the use of novel rapid molecular assays as initial diagnostic tests for TB and endorse alternative sample collection methods for children. However, the uptake of these tools in high-endemic settings remains low. In this review, we appraise historic and new microbiological tests and sample collection techniques that can be used for the diagnosis of intrathoracic TB in children. We explore challenges and possible ways to improve diagnostic yield despite limitations, and identify research gaps to address in order to improve the microbiological diagnosis of intrathoracic TB in children.
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