Kabir S, Choudhury S, Rahman T, Rahman S M M, Uddin M K M, Nashra A, Hossain A, Naher S, Towhid K M S, Shahrin L, Ahmed S, Daru P, Hoffmann J, Banu S
Progamme on Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
National Tuberculosis Control Programme, Dhaka, Bangladesh.
IJTLD Open. 2024 Oct 1;1(10):437-442. doi: 10.5588/ijtldopen.24.0334. eCollection 2024 Oct.
We describe the programmatic scale-up of stool testing using Xpert MTB/RIF Ultra (Ultra), as recommended by the WHO to improve childhood pulmonary TB (PTB) diagnosis.
USAID's Alliance for Combating TB in Bangladesh Activity, in collaboration with the National TB Control Programme, is implementing a stool-based diagnostic approach at 51 healthcare facilities in Bangladesh to improve PTB detection. Specimens from children (<15 years) with presumptive TB were tested using 'stool Ultra' with routine TB diagnostics. Physicians confirmed TB diagnosis and provided treatment as per national guidelines.
Between March 2022 and December 2023, 16,429 specimens were tested, 871 (5.3%) were positive, and 642 (73.7%) showed 'trace detected' results. Positivity was significantly higher among females, and children presented with 'only cough ≥2 weeks', 'cough ≥2 weeks + weight loss', or 'fever ≥2 weeks, weight loss, fatigue + contact history'. Positivity was higher among '10-14 years old' children; however, 'trace detected' was highest among '5-9 years', followed by children aged '>2-<5 years' and '0-2 years'.
Testing stools using Ultra provides a more effective way of diagnosing bacteriologically positive PTB in children. However, positivity varies with presenting symptoms/criteria, highlighting the need for careful diagnostic evaluation to ensure optimum use of limited diagnostic resources.
我们描述了按照世界卫生组织的建议，使用Xpert MTB/RIF Ultra（超敏）进行粪便检测的项目规模扩大情况，以改善儿童肺结核（PTB）的诊断。
美国国际开发署在孟加拉国的抗击结核病联盟活动与国家结核病控制项目合作，在孟加拉国的51个医疗机构实施基于粪便的诊断方法，以改善PTB检测。对疑似结核病的儿童（<15岁）的样本使用“粪便超敏检测”结合常规结核病诊断方法进行检测。医生根据国家指南确认结核病诊断并提供治疗。
在2022年3月至2023年12月期间，共检测了16429份样本，其中871份（5.3%）呈阳性，642份（73.7%）显示“检测到微量”结果。女性的阳性率显著更高，儿童表现为“仅咳嗽≥2周”、“咳嗽≥2周+体重减轻”或“发热≥2周、体重减轻、疲劳+接触史”。“10 - 14岁”儿童的阳性率更高；然而，“检测到微量”在“5 - 9岁”儿童中最高，其次是“>2 - <5岁”和“0 - 2岁”的儿童。
使用超敏检测法检测粪便为诊断儿童细菌学阳性PTB提供了一种更有效的方法。然而，阳性率因呈现的症状/标准而异，这突出了需要进行仔细的诊断评估，以确保有限的诊断资源得到最佳利用。
