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Singhal R, Dayal R, Bhatnagar S, Nayak M, Yadav N, Kumar P, Kumar S, Singh H, Singh G. Diagnostic Accuracy of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in Stool Samples in Pediatric Tuberculosis. Indian J Pediatr 2024; 91:1021-1026. [PMID: 37747634 DOI: 10.1007/s12098-023-04849-6] [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] [Received: 06/08/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES To find out the diagnostic accuracy of stool Cartridge-based nucleic acid amplification test (CBNAAT) as an alternate method as compared to CBNAAT in gastric aspirate (GA) samples in pediatric tuberculosis (TB). METHODS This cross-sectional study was performed at Department of Pediatrics of a tertiary care hospital. Children aged 0-18 y diagnosed as presumptive tuberculosis were consecutively enrolled. Gastric aspirate and corresponding stool sample was subjected to CBNAAT and its performance was compared in both samples using appropriate statistical tests. RESULTS Total 100 patients were enrolled in the study. Diagnostic accuracy of CBNAAT was 81% and 80% in gastric aspirate and stool sample respectively. On comparing gastric aspirate with corresponding stool sample there was 97% agreement, with Cohen's kappa value of 0.94. There was a statistically significant association observed between gastric aspirate CBNAAT and stool CBNAAT p <0.001 using chi square test. Sensitivity of gastric aspirate CBNAAT and stool CBNAAT was 75% and 73% respectively and specificity was 100% for both the samples compared against Composite Reference Standard (CRS). CONCLUSIONS The diagnostic accuracy of stool CBNAAT is comparable to GA CBNAAT in children and can be used as a good alternative to gastric aspirate for diagnosis of pulmonary and disseminated tuberculosis in children.
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Affiliation(s)
- Richa Singhal
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Rajeshwar Dayal
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India.
| | - Shailendra Bhatnagar
- Intermediate Reference Laboratory (IRL) State TB Training and Demonstration Center (STDC), Agra, India
| | - Madhu Nayak
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Neeraj Yadav
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Pankaj Kumar
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Santosh Kumar
- Department of Tuberculosis and Chest Diseases, S.N. Medical College, Agra, India
| | - Hari Singh
- Department of Radiodiagnosis, S.N. Medical College, Agra, India
| | - Geetu Singh
- Department of Preventive and Social Medicine, S.N. Medical College, Agra, India
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Singhal R, Dayal R, Bhatnagar S, Nayak M, Yadav N, Kumar P, Kumar S, Singh H, Singh G. Diagnostic Accuracy of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in Stool Samples in Pediatric Tuberculosis: Authors' Reply. Indian J Pediatr 2024; 91:1102-1103. [PMID: 38806967 DOI: 10.1007/s12098-024-05162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Richa Singhal
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Rajeshwar Dayal
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India.
| | - Shailendra Bhatnagar
- Intermediate Reference Laboratory (IRL), State TB Training and Demonstration Center (STDC), Agra, India
| | - Madhu Nayak
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Neeraj Yadav
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Pankaj Kumar
- Department of Pediatrics, S.N. Medical College, Agra, 282003, India
| | - Santosh Kumar
- Department of Tuberculosis and Chest Diseases, S.N. Medical College, Agra, India
| | - Hari Singh
- Department of Radiodiagnosis, S.N. Medical College, Agra, India
| | - Geetu Singh
- Department of Preventive and Social Medicine, S.N. Medical College, Agra, India
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Maciel EL, Lyrio Peres R, do Prado TN, Macedo CR, Palaci M, Alves Vinhas S, Dietze R, Johnson JL, Struchiner CJ. Saline nebulization before gastric lavage in the diagnosis of pulmonary tuberculosis in children and adolescents. J Trop Pediatr 2010; 56:458-9. [PMID: 20207695 PMCID: PMC3107460 DOI: 10.1093/tropej/fmq015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The main objective is to assess whether nebulization before gastric lavage (GL) improves its sensitivity for the diagnosis of childhood tuberculosis (TB). Children and adolescents suspected of pulmonary TB were randomly assigned (1 : 2) to nebulization with hypertonic saline 30 min before GL (Neb group; n = 36) or GL without prior nebulization (controls; n = 68). The proportion of positive GL smears was greater in Neb group than in the control group; however, no statistical significance was observed (36.3% vs. 22.2%; p = 0.4). Inhalation of nebulized hypertonic saline before GL did not improve TB diagnosis in this study. Nevertheless, the validation of our data will require large longitudinal studies.
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Affiliation(s)
- Ethel Leonor Maciel
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Renata Lyrio Peres
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Thiago Nascimento do Prado
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Cristina Ribeiro Macedo
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Moisés Palaci
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Solange Alves Vinhas
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - John L. Johnson
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
| | - Claúdio Jose Struchiner
- Núcleo de Doenças Infecciosas-NDI-Universidade Federal do Espírito Santo, Vitória, ES-Brazil, Hospital Nossa Senhora da Glória, Vitória, ES-Brazil, Case Western Reserve University, Tuberculosis Research Unit Cleveland-Ohio, and Oswaldo Cruz Foundation FIOCRUZ, Sérgio Arrouça Arouca National School of Public Health Rio de Janeiro-Brazil
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Maciel ELN, Brotto LDDA, Sales CMM, Zandonade E, Sant'anna CC. Gastric lavage in the diagnosis of pulmonary tuberculosis in children: a systematic review. Rev Saude Publica 2010; 44:735-42. [PMID: 20585739 DOI: 10.1590/s0034-89102010005000019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 12/20/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze standardization of gastric lavage protocols in the diagnosis of pulmonary tuberculosis in children. METHODS A systematic review was conducted for the period between 1968 and 2008 in the following databases: LILACS, SCIELO and MEDLINE. The search strategy included the following terms: "gastric lavage and tuberculosis" or "gastric washing and tuberculosis" with the restriction of "children aged up to 15 years;" "gastric lavage and tuberculosis and childhood" or "gastric washing and tuberculosis and childhood." There were retrieved 80 articles and their analysis was based on information on the gastric lavage protocol for the diagnosis of pulmonary tuberculosis in children: preparation of children and fasting; time of gastric aspiration; aspiration of gastric residues; total volume of aspirate; solution used for aspiration of gastric contents; decontaminant solution; buffer solution; and time for forwarding samples to the laboratory. After a thorough analysis, 14 articles were selected. RESULTS No article detailed the whole procedure. Some articles had missing information on: amount of gastric aspirate; aspiration before or after solution injection; solution used for gastric aspiration; buffer solution used; and waiting time between specimen collection and laboratory processing. These results showed inconsistencies of gastric lavage protocols. CONCLUSIONS Although gastric lavage is a secondary diagnostic approach used only in special cases that did not reach the diagnostic scoring as recommended by the Brazilian Ministry of Health, there is a need to standardize gastric lavage protocols for the diagnosis of pulmonary tuberculosis in children.
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Affiliation(s)
- Ethel Leonor Noia Maciel
- Departamento de Enfermagem, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil.
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