基于粪便的 Xpert MTB/RIF 检测在埃塞俄比亚西南部教学和转诊医院用于诊断儿童肺结核。
Stool-based Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children at a teaching and referral hospital in Southwest Ethiopia.
机构信息
Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia.
Department of Biology, Faculty of Natural and Computational Sciences, Gambella University, Gambella, Ethiopia.
出版信息
PLoS One. 2022 May 5;17(5):e0267661. doi: 10.1371/journal.pone.0267661. eCollection 2022.
BACKGROUND
Diagnosis of tuberculosis (TB) in children is challenging mainly due to the difficulty of obtaining respiratory specimen and lack of sensitive diagnostic tests. The objective of this study was to evaluate the diagnostic performance of Xpert MTB/RIF (Xpert here after) for the diagnosis of pulmonary TB (PTB) from stool specimen in children.
METHODS
A cross-sectional study was conducted among consecutively recruited children (less than 15 years old) with presumptive PTB at Jimma Medical Center, Ethiopia. One pulmonary specimen (expectorated sputum or gastric aspirate) was collected from each participant and tested for TB by Xpert and Lowenstein-Jensen (LJ) culture. In addition, one stool specimen per child was collected and tested by Xpert after a single step, centrifuge-free stool processing method adapted from KNCV TB Foundation. Diagnostic performance of Xpert was calculated with reference to LJ culture and to a composite reference standards (CRS) comprising of confirmed TB (positive by Xpert and/or culture) and unconfirmed TB (clinical diagnosis with improvement after anti-TB treatment).
RESULTS
A total of 178 children were enrolled; 152 of whom had complete microbiological results. Overall, TB was diagnosed in 13.2% (20/152) of the children with presumptive TB. Of these, only ten had microbiologically confirmed TB (positive Xpert and/or culture) and the remaining ten were clinically diagnosed with positive response to anti-TB treatment and were classified as unconfirmed TB. Stool Xpert had sensitivity of 100% (95%CI: 66.4-100) and specificity of 99.3% (95%CI: 96.2-100) compared to culture; however, the sensitivity was decreased to 50% (95%CI: 27.2-72.8) when compared to CRS. The Xpert on gastric aspirate had sensitivity of 77.8% (95%CI: 40-97.2) compared to culture and 40% (95%CI: 19.1-64) compared to CRS.
CONCLUSIONS
The sensitivity of Xpert for stool sample is comparable to that for gastric aspirate. Stool sample is a potential alternative to pulmonary specimen in the diagnosis of pulmonary TB in children using Xpert.
背景
儿童结核病（TB）的诊断具有挑战性，主要是因为难以获得呼吸道标本和缺乏敏感的诊断检测。本研究的目的是评估 Xpert MTB/RIF（以下简称 Xpert）检测粪便标本中儿童肺结核（PTB）的诊断性能。
方法
在埃塞俄比亚 Jimma 医疗中心，对疑似患有 PTB 的连续招募的儿童（年龄小于 15 岁）进行了一项横断面研究。每个参与者都采集了一份肺标本（咳出的痰液或胃抽吸物），并通过 Xpert 和 Lowenstein-Jensen（LJ）培养进行了 TB 检测。此外，根据 KNCV TB 基金会改编的一步离心自由粪便处理方法，每个孩子采集一份粪便标本，用 Xpert 进行检测。Xpert 的诊断性能是通过与 LJ 培养和复合参考标准（CRS）进行比较得出的，CRS 包括证实的 TB（Xpert 和/或培养阳性）和未证实的 TB（经抗 TB 治疗后临床诊断改善）。
结果
共有 178 名儿童入组，其中 152 名儿童有完整的微生物学结果。总体而言，13.2%（20/152）的疑似结核病儿童被诊断患有结核病。其中，只有 10 名儿童的结核病得到了微生物学证实（Xpert 和/或培养阳性），其余 10 名儿童经抗 TB 治疗后临床诊断改善，被归类为未证实的 TB。粪便 Xpert 与培养相比，其敏感性为 100%（95%CI：66.4-100），特异性为 99.3%（95%CI：96.2-100）；然而，与 CRS 相比，敏感性降低至 50%（95%CI：27.2-72.8）。胃液 Xpert 与培养相比，敏感性为 77.8%（95%CI：40-97.2），与 CRS 相比，敏感性为 40%（95%CI：19.1-64）。
结论
粪便标本中 Xpert 的敏感性与胃液标本相似。在使用 Xpert 诊断儿童肺结核时，粪便标本是肺部标本的潜在替代物。
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