Imperiale Belén Rocío, Nieves Cecilia, Mancino Belén, Sanjurjo Myriam, Tártara Silvina, Di Giulio Ángela Beatríz, Palomino Juan Carlos, Morcillo Nora Susana, Martin Anandi
Institute of Experimental Medicine-CONICET-National Academy of Medicine, Buenos Aires, Argentina.
Tuberculosis and Mycobacterioses Laboratory, Dr. Cetrangolo Hospital, Buenos Aires, Argentina.
Int J Mycobacteriol. 2018 Apr-Jun;7(2):162-166. doi: 10.4103/ijmy.ijmy_54_18.
There is a critical need to improve the diagnostic accuracy of tuberculosis (TB) in children. Several techniques have been developed to improve the quality of sputum samples; however, these procedures are very unpleasant and invasive and require hospitalization and trained personnel. This study aims to explore the potential use of a new and noninvasive tool, "string test," for TB diagnosis in children and in adults not able to render sputum samples and at risk of developing multidrug-resistant TB (MDR-TB).
Children with clinical suspicion of TB attending the pediatric consultation at the Cetrangolo or Cordero Hospitals and adults suspected of MDR-TB and unable to produce sputum attending the Infectious Disease Unit of Cetrangolo Hospital were included in this study.
The "string test" is a string that is swallowed by the patients and exposed to gastrointestinal secretions that were late analyzed for TB diagnosis and drug-resistance detection by GenoType MTBDRplus. MedCalc software was used to perform statistical analysis.
This technique could be applied on 62.1% of selected children. About 11 (30.6%) children were diagnosed as TB cases, 8 (22.2%) from gastric aspirate and using the "string test." Six out of 19 adults were also diagnosed. Genotype directly on the string specimen detected two MDR-TB in adults and two isoniazid-resistant cases before obtaining the isolate.
This test was safe, cheap, and easily implemented without requiring hospitalization. This research could represent a significant step forward to diagnose and rapidly detect drug-resistant TB in children.
提高儿童结核病（TB）诊断准确性的需求极为迫切。已开发出多种技术来提高痰液样本质量；然而，这些程序非常不适且具有侵入性，需要住院治疗以及专业人员操作。本研究旨在探索一种新型非侵入性工具“绳检法”在儿童及无法提供痰液样本且有发展为耐多药结核病（MDR-TB）风险的成人结核病诊断中的潜在应用。
本研究纳入了在Cetrangolo或Cordero医院儿科门诊临床怀疑患有结核病的儿童，以及在Cetrangolo医院传染病科怀疑患有耐多药结核病且无法咳出痰液的成人。
“绳检法”是让患者吞下一根绳子，使其接触胃肠道分泌物，随后通过GenoType MTBDRplus对分泌物进行结核病诊断及耐药性检测分析。使用MedCalc软件进行统计分析。
该技术可应用于62.1%的选定儿童。约11名（30.6%）儿童被诊断为结核病病例，其中8名（22.2%）通过胃抽吸物及“绳检法”确诊。19名成人中有6名也被诊断出来。在获得分离株之前，直接对绳检样本进行基因分型检测出2例成人耐多药结核病和2例异烟肼耐药病例。
该检测安全、廉价且易于实施，无需住院。这项研究可能是在儿童结核病诊断及快速检测耐药结核病方面向前迈出的重要一步。
