A1 Refereed original research article in a scientific journal
Performance of Xpert MTB/RIF and Mycobacterial Culture on Multiple Specimen Types for Diagnosis of Tuberculosis Disease in Young Children and Clinical Characterization According to Standardized Research Case Definitions
Authors: Click Eleanor S, Song Rinn, Smith Jonathan P, Mchembere Walter, Fajans Mark, Hariri Parisa, Okeyo Elisha, McCarthy Kimberly D, Gethi Dickson, Odeny Lazarus, Musau Susan, Okumu Albert, Orwa James, Perez-Velez Carlos M, Wright Colleen A, Andres Mariaem, Marais Ben J, Schaaf H Simon, Graham Stephen M, Cruz Andrea T, Cain Kevin P
Publisher: Lippincott Williams & Wilkins
Publication year: 2022
Journal: Pediatric Infectious Disease Journal
Journal name in source: The Pediatric infectious disease journal
Journal acronym: Pediatr Infect Dis J
Volume: 41
Issue: 8
First page : 671
Last page: 677
ISSN: 0891-3668
eISSN: 1532-0987
DOI: https://doi.org/10.1097/INF.0000000000003582
BACKROUND
Tuberculosis (TB) is a leading cause of illness and death in children globally. Improved bacteriologic and clinical diagnostic approaches in children are urgently needed.
METHODS
In a prospective cohort study, a consecutive series of young (<5 years) children presenting with symptoms suggestive of TB and parenchymal abnormality on chest radiograph in inpatient and outpatient settings in Kisumu County, Kenya from October 2013 to August 2015 were evaluated at baseline and over 6 months. Up to 14 specimens per child were tested for the Mycobacterium tuberculosis complex by fluorescence microscopy, Xpert MTB/RIF and mycobacterial culture. Using detailed clinical characterization, cases were retrospectively classified according to standardized research case definitions and the sensitivity and specificity of microbiological tests on different specimen types were determined.
RESULTS
Among 300 young children enrolled, 266 had sufficient information to be classified according to the research clinical case definition. Of these, 36% (96/266) had TB disease; 32% (31/96) with bacteriologically confirmed intrathoracic TB. Compared to culture, the sensitivity of a single Xpert test ranged from 60 to 67% and specificity from 97.5 to 100% for different specimen types.
CONCLUSIONS
Despite extensive specimen collection and laboratory testing, TB could not be bacteriologically confirmed in almost two-thirds of children with intrathoracic TB classified by research clinical case definitions. Improved diagnostic tests are needed to identify children with TB and to exclude other potential causes of illness.
