Effective testing for pulmonary tuberculosis using Xpert MTB/RIF assay for stool specimens in immunocompetent Pakistani children I n t e r n a t i o n a l J o u r n a l o f M y c o b a c t e r i o l o[.]
International Journal of Mycobacteriology ( ) S –S Available at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/IJMYCO Effective testing for pulmonary tuberculosis using Xpert MTB/RIF assay for stool specimens in immunocompetent Pakistani children Zahra Hasan a,*, Fehmina Arif b, Sadia Shakoor a, Aisha Mehnaz b, Alnoor Akber a, Akbar Kanji a, Mussarat Ashraf a, Rumina Hasan a a b Department of Pathology and Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, Pakistan Department of Pediatrics, Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan A R T I C L E I N F O A B S T R A C T Article history: Objective/background: Childhood tuberculosis (TB) is largely a paucibacillary disease and dif- Received 31 August 2016 ficult to diagnose It is difficult to obtain a sputum or gastric aspirate (GA) sample, and Accepted September 2016 patients are often undiagnosed and treated empirically Stool is a noninvasive specimen Available online 11 November 2016 not usually used for TB testing in Pakistan We investigated the value of Xpert MTB/RIF to diagnose Mycobacterium tuberculosis (MTB) in children with pulmonary TB cases, by Keywords: performing comparative testing of GA and stool samples Childhood tuberculosis Method: We recruited 60 children aged 1–15 years, suspected of TB, from the Department of Stool Pediatrics, Civil Hospital, Karachi, Pakistan and The Aga Khan University Hospital, Karachi, Xpert Pakistan All were immunocompetent Patients had a Kenneth Jones TB score of P5 Paired GA/sputum and stool samples were collected for testing All GA samples were tested by Xpert MTB/RIF assay and MTB culture, while stool was tested by Xpert MTB/RIF Results: The study participants included 27 males and 23 females with a mean age of years and a mean TB (Kenneth Jones) score of Stool was received in the laboratory within 1–2 days of the GA sample for all but one participant, who expired The rates of MTB detection were as follows: 22% (11 cases) based on Xpert MTB testing of GA, 21% (10 cases) based on MTB culture of GA, and 21% (10 cases) based on Xpert MTB testing of stool No rifampicin resistance was detected Overall, there was concordance between testing of GA and stool One case had GA with low positive Xpert and positive MTB culture, but negative stool Xpert result In another case, there was low positive GA Xpert, positive GA MTB culture, and positive stool Xpert A positive Xpert MTB stool test was associated with a higher TB score (>5) and a greater bacillary load All 11 cases of TB diagnosed were put on antituberculous therapy and responded well to treatment Conclusion: Use of Xpert MTB/RIF assay for stool-based diagnosis of pulmonary TB in immunocompetent children is useful in a resource poor setting This is a valuable and noninvasive diagnostic alternative for the diagnosis of childhood TB and can be adapted by pediatric arms of national TB programs * Corresponding author E-mail address: zahra.hasan@aku.edu (Z Hasan) Peer review under responsibility of Asian African Society for Mycobacteriology http://dx.doi.org/10.1016/j.ijmyco.2016.09.068 International Journal of Mycobacteriology Conflicts of interest All authors declare no conflicts of interest ( ) S –S S9 ...International Journal of Mycobacteriology Conflicts of interest All authors declare no conflicts of interest ( ) S –S S9