Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia.
Department of Pediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain.
J Trop Pediatr. 2022 Jun 6;68(4). doi: 10.1093/tropej/fmac055.
This study assesses the impact of the Xpert MTB/RIF in the diagnosis of childhood tuberculosis (TB) in a rural hospital in a resource-constrained setting.
Retrospective cross-sectional study in children evaluated for presumptive TB from 1 June 2016 to 31 May 2017 at the Gambo General Hospital in rural Southern Ethiopia. Children were evaluated according to a defined protocol based on national guidelines. Samples were submitted for Xpert MTB/RIF assay to the nearest reference laboratory.
Of the 201 children assessed for presumptive TB, 46.3% (93/201) were diagnosed with TB. Of these, 49.5% (46/93) were microbiologically confirmed, mostly by Xpert MTB/RIF (only one patient was diagnosed by smear alone). The rest were clinically diagnosed. Microbiologically confirmed patients had a higher mean age, longer duration of fever and cough and lymphadenopathy more frequently than those clinically diagnosed. Gastric aspirates were Xpert MTB/RIF-positive in 18.2% of the samples (26/143); none were smear-positive (0/140). Sputum samples were Xpert MTB/RIF-positive in 27.1% (13/35) of the samples and smear-positive in 8.6% (3/35). There were no HIV-positive patients and just one case of rifampicin-resistant TB. A long delay (median 15 days) was detected in returning the results.
Xpert MTB/RIF serves as an important adjunctive test for diagnosing childhood TB in rural settings, with microbiological confirmation in up to half the TB cases. Processes need to be optimized to achieve an early diagnosis. The diagnosis of childhood TB in high-burden countries such as Ethiopia still relies largely upon diagnostic algorithms and the clinician's skills.Lay summaryWorld Health Organization recommends the use of Xpert MTB/RIF to improve the microbiological diagnosis of childhood tuberculosis (TB) since 2014, but the impact of this test under real conditions in rural areas of low-income countries is not clear. We conducted a cross-sectional study in children evaluated for presumptive TB from 1 June 2016 to 31 May 2017 at the Gambo General Hospital in rural Southern Ethiopia. Children were evaluated according to a clinical protocol based on national guidelines and samples were submitted for Xpert MTB/RIF assay to the nearest reference laboratory.Of the 201 children assessed, 46.3% (93/201) were diagnosed with tuberculosis. Of these, 48.4% (45/93) were microbiologically confirmed by Xpert MTB/RIF [smear microscopy only diagnosed the 5.4% (5/93)]. Patients with microbiologically confirmed tuberculosis had a higher mean age, longer duration of fever and cough and had lymphadenopathy more frequently than those clinically diagnosed. A long delay in returning the results (median 15 days) was detected. Xpert MTB/RIF serves as an important test for diagnosing childhood TB in rural settings, with microbiological confirmation in up to half the cases. Processes need to be optimized to achieve an early diagnosis. The diagnosis of childhood TB in high-burden countries still relies largely upon diagnostic algorithms and the clinician's skills.
本研究评估了 Xpert MTB/RIF 在资源有限环境下农村医院儿童结核病（TB）诊断中的作用。
对 2016 年 6 月 1 日至 2017 年 5 月 31 日在埃塞俄比亚南部农村的甘博综合医院接受疑似结核病评估的儿童进行回顾性横断面研究。根据国家指南制定的既定方案对儿童进行评估。将样本提交至最近的参考实验室进行 Xpert MTB/RIF 检测。
在 201 名接受疑似结核病评估的儿童中，46.3%（93/201）被诊断为结核病。其中，49.5%（46/93）通过 Xpert MTB/RIF 进行了微生物学确认，主要通过 Xpert MTB/RIF 进行（仅有一名患者单独通过涂片确诊）。其余为临床诊断。微生物学确诊患者的平均年龄较高，发热、咳嗽和淋巴结病的持续时间较长，且更常出现淋巴结病。胃抽吸物中 Xpert MTB/RIF 阳性率为 18.2%（26/143）；无涂片阳性（0/140）。痰样本中 Xpert MTB/RIF 阳性率为 27.1%（13/35），涂片阳性率为 8.6%（3/35）。无 HIV 阳性患者，仅有 1 例利福平耐药性结核病。结果返回时间长（中位数 15 天）。
Xpert MTB/RIF 可作为农村地区儿童结核病诊断的重要辅助检测手段，在一半的结核病病例中可进行微生物学确认。需要优化流程以实现早期诊断。在像埃塞俄比亚这样的高负担国家，儿童结核病的诊断仍然主要依赖于诊断算法和临床医生的技能。
