Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
BMC Infect Dis. 2013 Mar 12;13:133. doi: 10.1186/1471-2334-13-133.
The diagnosis of childhood tuberculosis remains a challenge worldwide. The Xpert MTB/RIF test, a rapid mycobacteria tuberculosis diagnostic tool, was recommended for use in children based on data from adult studies. We evaluated the performance of the Xpert MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis using one induced sputum sample and described clinical characteristics associated with a positive Xpert MTB/RIF test. The sputum culture on both Lowenstein-Jensen (LJ) and Mycobacteria Growth Indicator Tube (MGIT) was the gold standard.
We consecutively enrolled 250 Ugandan children aged 2 months to 12 years with suspected pulmonary tuberculosis between January 2011 and January 2012 into a cross-sectional diagnostic study at a tertiary care facility in Uganda.
We excluded data from 15 children (13 contaminated culture and 2 indeterminate MTB/RIF test results) and analysed 235 records. The Xpert MTB/RIF test had a sensitivity of 79.4% (95% CI 63.2 - 89.7) and a specificity of 96.5% (95% CI 93 - 98.3). The Xpert MTB/RIF test identified 13 of the 14 (92.9%) smear positive-culture positive and 14 of the 20 (70%) smear negative -culture positive cases. The Xpert MTB/RIF identified twice as many cases as the smear microscopy (79.4% Vs 41.2%). Age > 5 years (OR 3.3, 95% CI 1.4 - 7.4, p value 0.005), a history of Tuberculosis (TB) contact (OR 2.4, 95% CI 1.1 - 5.2, p value 0.03), and a positive tuberculin skin test (OR 4.1, 95% CI 1.7 - 10, p value 0.02) was associated with a positive Xpert MTB/RIF test. The median time to TB detection was 49.5 days (IQR 38.4-61.2) for LJ, and 6 days (IQR 5 - 11.5) for MGIT culture and 2 hours for the Xpert MTB/RIF test.
The Xpert MTB/RIF test on one sputum sample rapidly and correctly identified the majority of children with culture confirmed pulmonary tuberculosis with high specificity.
儿童结核病的诊断仍然是一个全球性的挑战。Xpert MTB/RIF 检测是一种快速分枝杆菌结核诊断工具，其在儿童中的应用基于成人研究的数据。我们评估了使用一份诱导痰样本诊断儿童肺结核的 Xpert MTB/RIF 检测的性能，并描述了与 Xpert MTB/RIF 检测阳性相关的临床特征。痰培养的金标准是 Lowenstein-Jensen（LJ）和分枝杆菌生长指示管（MGIT）。
我们连续纳入了 2011 年 1 月至 2012 年 1 月在乌干达一家三级医疗机构接受疑似肺结核的 250 名 2 个月至 12 岁的乌干达儿童，进行横断面诊断研究。
我们排除了 15 名儿童的数据（13 名培养物污染和 2 名 MTB/RIF 检测结果不确定），并分析了 235 份记录。Xpert MTB/RIF 检测的敏感性为 79.4%（95%CI 63.2-89.7），特异性为 96.5%（95%CI 93-98.3）。Xpert MTB/RIF 检测发现了 14 例（70%）培养阳性但涂片阴性的病例中的 14 例（13 例涂片阳性-培养阳性和 14 例涂片阴性-培养阳性）。Xpert MTB/RIF 检测比涂片显微镜检查多发现了两倍的病例（79.4%对 41.2%）。年龄>5 岁（比值比 3.3，95%CI 1.4-7.4，p 值 0.005）、结核病（TB）接触史（比值比 2.4，95%CI 1.1-5.2，p 值 0.03）和结核菌素皮肤试验阳性（比值比 4.1，95%CI 1.7-10，p 值 0.02）与 Xpert MTB/RIF 检测阳性相关。LJ 培养的 TB 检出中位时间为 49.5 天（IQR 38.4-61.2），MGIT 培养为 6 天（IQR 5-11.5），Xpert MTB/RIF 检测为 2 小时。
使用一份痰样本的 Xpert MTB/RIF 检测快速且正确地识别了大多数培养确诊为肺结核的儿童，特异性高。
