Evaluating role of GeneXpert Mycobacterium tuberculosis and rifampin in diagnosing pediatric tuberculosis

Junaid Ul Islam; Parvez Ahmed Lone

doi:10.18203/2349-3291.ijcp20243079

Authors

Junaid Ul Islam Department of Pediatrics, SKIMS, Jammu and Kashmir, India
Parvez Ahmed Lone Department of Pediatrics, SKIMS, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20243079

Keywords:

Mycobacterium tuberculosis, GeneXpert, BAL, Smear microscopy, LJ culture

Abstract

Background: Tuberculosis (TB), an ancient disease, co-evolved with humans for thousands of years. The earliest known molecular evidence was found in a neolithic settlement in the Eastern Mediterranean. The pulmonary form was associated with "tubercles" as early as 1689. The Mycobacterium tuberculosis complex, including M. bovis, M. microti, and M. africanum, is the principal cause of human TB. Despite newer diagnostic and treatment methods, millions still suffer and die from TB.

Methods: Between 2015 and 2017, a study at Dalgate Srinagar's intermediate reference laboratory focused on tuberculin sensitivity tests in children with HIV and non-HIV infections. Samples were collected from sputum/gastric aspirate and BAL samples, and Xpert MTB/RIF tests were performed within two hours. Quality control measures were implemented.

Results: The study analyzed 137 patients with TB, collecting 227 samples. GeneXpert was the most common test, with 26 patients showing maximum positivity. LJ culture was the most common, with 24 patients showing maximum positivity. Smear microscopy was the most common, with 22 patients showing maximum positivity. GeneXpert, AFB smear, and LJ culture had 63.9%, 63.2%, and 66.7% sensitivity, specificity, and PPV, respectively.

Conclusions: A study of 137 pediatric TB patients found that GeneXpert and LJ cultures had higher positivity rates than smear microscopy and LJ culture. Adding GeneXpert to the pediatric diagnostic algorithm could increase the number of microbiologically detected cases. However, sensitivity remains low, highlighting the need for improved diagnostic tests and algorithmic approaches.

Metrics

Metrics Loading ...

References

Hirsh AE, Tsolaki AG, DeRiemer K, Feldman MW, Small PM. Stable association between strains of Mycobacterium tuberculosis and their human host populations. Proc Natl Acad Sci USA. 2004;101:4871-6.

Rothschild BM, Martin LD, Lev G, Bercovier H, Bar-Gal GK, Greenblatt CL, et al. Mycobacterium tuberculosis Complex DNA from an Extinct Bison Dated 17,000 Years before the Present. ClinInfec Dis. 2001;33:305-11.

News-medical.net. History of Tuberculosis. Available at: http://www.news-medical.net/health/History-of-Tuberculosis.aspx. Accessed on 15 August 2024.

Geneva: WHO; 2010. World Health Organization. Fact Sheet No.104: Tuberculosis. Available at: http://www.who.int/mediacentre/factsheets/fs104/en/print.html. Accessed on 15 August 2024.

Dolin PJ, Raviglione MC, Kochi A. Global tuberculosis incidence and mortality during 19902000.Bull World Health Organ. 1994;72(2):213-20.

Walls T, Shingadia D. Global epidemiology of paediatric tuberculosis. J Infect. 2004;48(1):13-22.

Global tuberculosis control-epidemiology, strategy, financing. WHO Report. 2009. Available at: http://www.who.int/tb/ publications/global_ report/ 2009/en/ index.html. Accessed on 31 August 2024.

Global Tuberculosis Control: WHO report 2014, World Health Organization, Geneva 2014. WHO/HTM/TB/2014.08

The Registrar General and Census Commissioner, India, New Delhi, Ministry of Home Affairs, Government of India. Available at: http://www.censusindia.gov.in/Census_Data_2001/India_at_Glance/broad.aspx. Accessed on 31 August 2024.

Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis. 2008;8:498-510.

Eamranond P, Jaramillo E: Tuberculosis in children: reassessing the need for improved diagnosis in global control strategies. Int J Tuberc Lung Dis. 2001;5(7):594-603.

Lighter J, Riguaud M. Diagnosing childhood tuberculosis: traditional and innovative modalities. Curr Probl Pediatr Adolesc Health Care. 2009;39(3):61-88.

Cepheid: GeneXpert System. Available at: http://www.cepheid.com/systemsandsoftware/genexpertsystem. Accessed on 31 August 2024.

IAP working group. Treatment of childhood tuberculosis: consensus statement of IAP working group. Indian Pediatr. 2010;47:42-3.

Blakemore R, Story E, Helb D, Kop J, Banada P, Owens M, et al. Evaluation of the analytical performance of the Xpert MTB/RIF assay. J. Cin Microbiol. 2010;48:2495-501.

Piatek AS, Tyagi S, Pol AC, Telenti A., Miller LP, Kramer FR, et al. Molecular beacon sequence analysis for detecting drug resistance in mycobacterium tuberculosis. Nat. Biotechnol. 1998;16:359-63.

World Health Organisation. Global Tuberculosis Report. Geneva, Switzerland: WHO/HTM/TB/2014.08; 2014. Available at: http://www.who.int/tb/publications/globalreport/en/. Accessed on 30 August 2024.

Kelynack T. Tuberculosis in Infancy and Children. New York: William wood and Co. 1908.

Abadco DL, Steiner P. Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis. Pediatr Infect Dis J. 1992;11(9):735-8.

World Health Organization. Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children. World Health Organization, Geneva, Switzerland: Policy update. 2013.

Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF Assay for Rapid Diagnosis of Tuberculosis and Detection of Rifampin Resistance in Pulmonary and Extrapulmonary Specimens. J Clin Microbiol. 2011;49(12):4138-41.

Tiwari S, Nataraj G, Kanade S, Mehta P. Diagnosis of pediatric pulmonary tuberculosis with special reference to polymerase chain reaction based nucleic acid amplification test. Int J Mycobacteriol. 2015;4:48-53.

Rachow A, Clowes P, Saathoff E, Mtafya B, Michael E, Ntinginya EN, et al. Increased and expedited case detection by Xpert MTB/RIF assay in childhood tuberculosis: a prospective cohort study. Clin Infect Dis. 2012;54(10):1388-96.

Nicol MP, Workman L, Isaacs W, Munro J, Black F, Eley B, et al. Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study. Lancet Infect Dis. 2011;11(11):819-24.

Do CG, Tran ND, Dang TMH, Ho TN, Marcel W, Nguyen TQN, et al. Prospective evaluation of GeneXpert for the diagnosis of HIV- negative pediatric TB cases. BMC Infectious Dis. 2015;15:70.

Sekadde MP, Wobudeya E, Joloba ML, Ssengooba W, Kisembo H, Bakeera-Kitaka S, et al. Evaluation of the Xpert MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis in Uganda: a cross-sectional diagnostic study. BMC Infect Dis. 2013;13:133.