Format

Send to

Choose Destination
J Clin Microbiol. 2018 Aug 27;56(9). pii: e00781-18. doi: 10.1128/JCM.00781-18. Print 2018 Sep.

Molecular Detection of Mycobacterium tuberculosis from Stools in Young Children by Use of a Novel Centrifugation-Free Processing Method.

Author information

1
Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa ewal@sun.ac.za.
2
Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
3
Foundation for Innovative New Diagnostics, Geneva, Switzerland.
4
Desmond Tutu TB Centre, Stellenbosch University, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
5
Rahima Moosa Mother & Child Hospital, University of the Witwatersrand, Faculty of Health Sciences, Paediatrics and Child Health, Johannesburg, South Africa.
6
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
7
Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
8
Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
9
National Priority Program of the National Health Laboratory Service, Johannesburg, South Africa.
10
Rutgers, New Jersey Medical School, Faculty of Medicine, Newark, New Jersey, USA.
#
Contributed equally

Abstract

The microbiological diagnosis of tuberculosis (TB) in children is challenging, as it relies on the collection of relatively invasive specimens by trained health care workers, which is not feasible in many settings. Mycobacterium tuberculosis is detectable from the stools of children using molecular methods, but processing stool specimens is resource intensive. We evaluated a novel, simple, centrifugation-free processing method for stool specimens for use on the Xpert MTB/RIF assay (Xpert), using two different stool masses: 0.6 g and a swab sample. Two hundred eighty children (median age, 15.5 months; 35 [12.5%] HIV infected) with suspected intrathoracic TB were enrolled from two sites in South Africa. Compared to a single Xpert test on respiratory specimens, the sensitivity of Xpert on stools using the 0.6-g and swab samples was 44.4% (95% confidence interval [CI], 13.7 to 78.8%) for both methods, with a specificity of >99%. The combined sensitivities of two stool tests versus the first respiratory Xpert were 70.0% (95% CI, 34.8 to 93.3) and 50.0% (95% CI, 18.7 to 81.3) for the 0.6-g and swab sample, respectively. Retesting stool specimens with nondeterminate Xpert results improved nondeterminate rates from 9.3% to 3.9% and from 8.6% to 4.3% for 0.6-g and swab samples, respectively. Overall, stool Xpert detected 14/94 (14.9%) children who initiated antituberculosis treatment, while respiratory specimens detected 23/94 (24.5%). This stool processing method is well suited for settings with low capacity for respiratory specimen collection. However, the overall sensitivity to detect confirmed and clinical TB was lower than that of respiratory specimens. More sensitive rapid molecular assays are needed to improve the utility of stools for the diagnosis of intrathoracic TB in children from resource-limited settings.

KEYWORDS:

children; diagnosis; stool; tuberculosis

PMID:
29997199
PMCID:
PMC6113478
DOI:
10.1128/JCM.00781-18
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center