Bek Folkvardsen Dorte, Naestholt Dahl Victor, Wejse Christian, Svensson Erik, Lillebaek Troels
International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark.
Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
J Clin Tuberc Other Mycobact Dis. 2024 Nov 26;37:100498. doi: 10.1016/j.jctube.2024.100498. eCollection 2024 Dec.
Patients with pulmonary tuberculosis (PTB) may face challenges in providing sputum specimens for diagnosis. Mycobacterium tuberculosis (Mtb) is potentially present in the stool due to swallowed sputum. Therefore easy-to-obtain stool could be used as an alternative to sputum sampling. However, the evidence for using stool specimens for PTB diagnosis is sparse, especially in resource-rich settings. In this study, spanning two years, the results of 562 stool specimens were evaluated alongside those of respiratory specimens sent to the International Reference Laboratory of Mycobacteriology in Denmark. Despite the potential advantages of stool culture, only five out of 19 patients with PTB had Mtb culture-positive stool, all of whom also had positive respiratory specimens. Conversely, relying solely on stool specimens could lead to missed diagnoses of PTB. While stool analysis may offer additional value in specific settings or populations, such as those unable to produce sputum, this study discourages its general use for PTB testing in resource-rich, TB low-incidence settings like Denmark. Instead, we advocate for prospective trials in specific subpopulations to elucidate the role of stool as a complementary diagnostic tool for PTB. The study underscores the importance of tailoring diagnostic approaches based on the setting and patient characteristics.
肺结核（PTB）患者在提供痰液样本用于诊断时可能会面临挑战。由于痰液被吞咽，结核分枝杆菌（Mtb）可能存在于粪便中。因此，易于获取的粪便可作为痰液采样的替代方法。然而，使用粪便样本进行PTB诊断的证据很少，尤其是在资源丰富的环境中。在这项为期两年的研究中，对562份粪便样本的结果与送往丹麦国际分枝杆菌学参考实验室的呼吸道样本的结果进行了评估。尽管粪便培养有潜在优势，但19例PTB患者中只有5例粪便Mtb培养呈阳性，且所有这些患者的呼吸道样本也呈阳性。相反，仅依靠粪便样本可能会导致PTB漏诊。虽然粪便分析在特定环境或人群（如无法咳痰者）中可能具有额外价值，但本研究不鼓励在丹麦等资源丰富、结核病低发病率的环境中普遍将其用于PTB检测。相反，我们主张在特定亚人群中进行前瞻性试验，以阐明粪便作为PTB补充诊断工具的作用。该研究强调了根据环境和患者特征调整诊断方法的重要性。
