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Kaboré OD, Millogo A, Sanogo B, Birba E, Poda A, Nacro B, Marcy O, Godreuil S, Ouédraogo AS. Analytical performances of the Xpert MTB/RIF assay using stool specimens to improve the diagnosis of pulmonary tuberculosis in Burkina Faso, a tuberculosis endemic country. PLoS One 2023; 18:e0288671. [PMID: 37523357 PMCID: PMC10389731 DOI: 10.1371/journal.pone.0288671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/01/2023] [Indexed: 08/02/2023] Open
Abstract
Timely diagnosis of Pulmonary Tuberculosis (PTB) is associated with good prognosis, but remains difficult in primary healthcare facilities and particularly in children and patients living with HIV. The aim of this study was to compare the GeneXpert ® MTB/RIF assay (Xpert) performed using a stool sample (3-5 g) and using the first Respiratory Tract Sample (RTS; i.e., sputum, bronchoalveolar or gastric aspirate; as normally done) concomitantly collected from 119 patients with suspected PTB to improve PTB diagnosis in Burkina Faso, a high tuberculosis burden country with limited resources. Overall, microbiological, microscopic and molecular analysis of the 119 first RTS and 119 stool specimens led to Mycobacterium tuberculosis complex detection in 28 patients (23 positive RTS cultures and 5 negative RTS cultures-RTS Xpert positive). When using the 28 clinical confirmed cases as reference standard, the sensitivities of the stool-based and RTS-based Xpert assays were not different (24/28, 85.7%, versus 26/28, 92.86%; p > 0.30), and 22 results were fully concordant. Considering the first RTS culture as the gold standard, the sensitivities of the stool-based and RTS-based Xpert assays to detect PTB in patients with positive RTS culture were 100% (23/23) and 91.3% (21/23), respectively (p >0.05). The stool-based Xpert assay specificity for excluding PTB was 99% (95/96) (compared with 95%, 91/96, when using RTS) and its negative and positive predictive values were 100% (95/95) and 96% (23/24), respectively. Compared with the 23 positive RTS cultures, the incremental yield rates of the RTS-based and stool-based Xpert assays were 4.2% (5/119) and 0.84% (1/119), respectively. Overall, our findings support using the stool-based Xpert assay as an alternative method for earlier PTB diagnosis, when RTS are difficult to obtain.
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Affiliation(s)
- Odilon D Kaboré
- Department of Bacteriology and Virology, Souro Sanou University Hospital, Bobo Dioulasso, Burkina Faso
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens, School of Health Sciences Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | - Anselme Millogo
- Department of Bacteriology and Virology, Souro Sanou University Hospital, Bobo Dioulasso, Burkina Faso
| | - Bintou Sanogo
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Département de Pédiatrie du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Emile Birba
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Service de Pneumologie-Phtisiologie du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens, School of Health Sciences Nazi Boni University, Bobo Dioulasso, Burkina Faso
- Service des Maladies Infectieuses du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Boubacar Nacro
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Département de Pédiatrie du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Olivier Marcy
- Bordeaux Population Health Research Center Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, CHU de Montpellier, MIVEGEC (IRD, CNRS, Université de Montpellier), Montpellier, France
| | - Abdoul-Salam Ouédraogo
- Department of Bacteriology and Virology, Souro Sanou University Hospital, Bobo Dioulasso, Burkina Faso
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens, School of Health Sciences Nazi Boni University, Bobo Dioulasso, Burkina Faso
- Muraz Center, Bobo Dioulasso, Burkina Faso
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Sultana S, Afrin S, Hasan M, Ansar A, Saif-Ur-Rahman KM. Stool specimen for diagnosis of pulmonary tuberculosis in adults: a systematic review. BMJ Open 2023; 13:e062135. [PMID: 37105702 PMCID: PMC10151869 DOI: 10.1136/bmjopen-2022-062135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy of stool specimens to diagnose pulmonary tuberculosis (PTB) in adults. DESIGN Systematic review. DATA SOURCES MEDLINE (Ovid), Embase (Ovid), Web of Science and the Cochrane database were searched from inception to 9 March 2023-10 March 2023 using a comprehensive search strategy; reference lists of selected articles and relevant review articles were manually searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies in English reporting diagnostic performance of stool specimens against respiratory specimens using mycobacterial culture or smear microscopy or Xpert assay to diagnose PTB in adults were eligible for this systematic review. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the retrieved citations and extracted data. The risk of bias and applicability of results were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Narrative data synthesis was performed. RESULTS A total of 1658 citations were screened, and 28 full-text articles were assessed. Nine studies met the inclusion criteria. The reported sensitivity and specificity of stool culture varied between 21.4% and 63.9%, and 61.5% and 100%, respectively. In stool smear microscopy, sensitivities and specificities ranged from 12.1% to 53.9%, and from 79.5% to 100%, respectively. The reported sensitivities of PCR assays, including Xpert assays, ranged from 69.7% to 100%, with specificities ranging from 69.8% to 100%. Most of the studies had a low risk of bias and a low applicability concern in all domains. CONCLUSION This systematic review could not conclude on the diagnostic accuracy of stool specimens for PTB diagnosis in adults. Further studies are required to evaluate the accuracy of stool specimens in adults to enable meta-analyses in updates of this review as well as other systematic reviews. PROSPERO REGISTRATION NUMBER CRD42021245203.
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Affiliation(s)
| | - Sadia Afrin
- Health Systems and Population Studies Division, ICDDRB, Dhaka, Bangladesh
| | | | - Adnan Ansar
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, ICDDRB, Dhaka, Bangladesh
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
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Sessolo A, Musisi E, Kaswabuli S, Zawedde J, Byanyima P, Sabiiti W, Walimbwa S, Ola J, Sanyu I, Lalitha R, Kamya M, Davis L, Worodria W, Huang L. Diagnostic accuracy of Xpert MTB/RIF Ultra and culture assays to detect Mycobacterium Tuberculosis using OMNIgene-sputum processed stool among adult TB presumptive patients in Uganda. PLoS One 2023; 18:e0284041. [PMID: 37083706 PMCID: PMC10121033 DOI: 10.1371/journal.pone.0284041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Stool is a potential sample for diagnosing Mycobacterium tuberculosis (Mtb) in patients with difficulty in expectorating. However, high mycobacterial culture contamination rates and Xpert MTB/RIF Ultra test error rates on stool samples have limited its use. OMNIgene SPUTUM (OM-S) is a sample transport reagent with characteristics of sputum decontamination while maintaining viable Mtb. We evaluated the impact of OM-S on Mtb diagnostic yield from stool using smear microscopy, Xpert MTB/RIF Ultra, and culture among presumptive TB patients. METHODS Paired stool and expectorated sputum samples were collected from consecutive Ugandan adults undergoing diagnostic evaluation for pulmonary TB between June 2018 and June 2019. Stool was divided into 2 portions: one was homogenized in OM-S (OM-S stool) and the other in PBS (PBS stool) as control. Both sputum and processed stool were tested for Mtb using concentrated smear fluorescence microscopy (CFM), Xpert MTB/RIF Ultra (Xpert) and Mycobacteria Growth Indicator Tube (MGIT) culture. Sensitivity, specificity, and predictive values for each test were calculated against sputum MGIT culture as the reference standard. RESULTS Of the 200 participants, 120 (60%) were male, 73 (37%) were HIV positive (median CD4 120 cells/uL (IQR 43-297)) and 128 (64%) had confirmed pulmonary TB by sputum MGIT culture. Seven (4%) OM-S stool Xpert samples reported errors while 47 (25%) and 103 (61%) were contaminated on OM-S stool MGIT and PBS stool MGIT, respectively. OM-S stool MGIT was able to accurately diagnose 56 of the contaminated PBS stool MGIT samples compared to only 5 of the contaminated OM-S stool MGIT samples diagnosed by PBS stool MGIT. Sensitivity (95% Confidence Interval, CI) 89% (83-94) for OM-S stool Xpert was higher compared to that of OM-S stool MGIT 60% (51-69) and PBS stool MGIT 42% (32-52). Specificity (95%CI) 91% (82-97) was also higher for OM-S stool Xpert compared to OM-S stool MGIT 64% (51-75) and PBS stool MGIT 26% (16-38). CONCLUSION Stool processed with OM-S showed potential to improve Mtb diagnostic yield and reduce rates of indeterminate results when tested on Xpert and MGIT culture. The method may thus be of value in Mtb detection among patients with difficulty to expectorate.
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Affiliation(s)
| | - Emmanuel Musisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Biochemistry and Sports Science, Makerere University, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, Scotland, United Kingdom
| | | | | | | | - Wilber Sabiiti
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, Scotland, United Kingdom
| | | | - Joseph Ola
- China Uganda Friendship Hospital Naguru, Kampala, Uganda
| | - Ingvar Sanyu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Rejani Lalitha
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Laurence Huang
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, United States of America
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Rojas-Ponce G, Sauvageau D, Zemp R, Barkema HW, Evoy S. Use of uncoated magnetic beads to capture Mycobacterium smegmatis and Mycobacterium avium paratuberculosis prior detection by mycobacteriophage D29 and real-time-PCR. J Microbiol Methods 2022; 197:106490. [PMID: 35595085 DOI: 10.1016/j.mimet.2022.106490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022]
Abstract
Uncoated tosyl-activated magnetic beads were evaluated to capture Mycobacterium smegmatis and Mycobacterium avium subspecies paratuberculosis (MAP) from spiked feces, milk, and urine. Centrifugation and uncoated magnetic beads recovered more than 99% and 93%, respectively, of 1.68 × 107 CFU/mL, 1.68 × 106 CFU/mL and 1.68 × 105 CFU/mL M. smegmatis cells resuspended in phosphate buffer saline. The use of magnetic beads was more efficient to concentrate cells from 1.68 × 104 CFU/mL of M. smegmatis than centrifugation. Likewise, the F57-qPCR detection of MAP cells was different whether they were recovered by beads or centrifugation; cycle threshold (Ct) was lower (p < 0.05) for the detection of MAP cells recovered by beads than centrifugation, indicative of greater recovery. Magnetic separation of MAP cells from milk, urine, and feces specimens was demonstrated by detection of F57 and IS900 sequences. Beads captured no less than 109 CFU/mL from feces and no less than 104 CFU/mL from milk and urine suspensions. In another detection strategy, M. smegmatis coupled to magnetic beads were infected by mycobacteriophage D29. Plaque forming units were observed after 24 h of incubation from urine samples containing 2 × 105 and 2 × 103 CFU/mL M. smegmatis. The results of this study provide a promising tool for diagnosis of tuberculosis and Johne's disease.
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Affiliation(s)
- Gabriel Rojas-Ponce
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada.
| | - Dominic Sauvageau
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Roger Zemp
- Department of Electrical and Computer Engineering, Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Herman W Barkema
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephane Evoy
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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Konno A, Narumoto O, Matsui H, Takeda K, Hirano Y, Shinfuku K, Tashimo H, Kawashima M, Yamane A, Tamura A, Nagai H, Ohta K, Tohma S. The benefit of stool mycobacterial examination to diagnose pulmonary tuberculosis for adult and elderly patients. J Clin Tuberc Other Mycobact Dis 2019; 16:100106. [PMID: 31720430 PMCID: PMC6830132 DOI: 10.1016/j.jctube.2019.100106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background In patients with suspected pulmonary tuberculosis, who have difficulty in expectorating sputum, alternative specimens by invasive procedures, gastric aspirate or sputum suction, are not always available in the feeble elderly. Several studies report the benefit of stool test for pediatric or HIV infected patients, but few in adult patients. Objective To evaluate the benefit of stool examination as non-invasive alternative test to detect Mycobacterium tuberculosis (MTB) infection. Methods Stool specimens were examined for mycobacteria in 187 cases of microbiologically-diagnosed pulmonary tuberculosis between September 2013 and August 2017. We retrospectively reviewed the medical records to determine the positive detection rate of MTB with stool specimens and investigated factors related to MTB detection. Results Among 187 patients included, positive rate of MTB in stool was 12.8% (24/187) by stool acid-fast bacilli smear, 68.1% (98/144) by TRC Rapid®, and 40.6% (76/187) by culture. Multivariate logistic regression analysis revealed two contributing factors to MTB detection in stool; cavitation and male. The adjusted odds ratio with 95% confidence interval (CI) for cavitation was 2.9 (95%CI 1.48–5.69) and 2.1 (95%CI 1.08–3.93) for male. Conclusion We recommend stool examination for those who are unable to give sputum and have risks for invasive procedures.
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Affiliation(s)
- Aya Konno
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Osamu Narumoto
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
- Corresponding author.
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Keita Takeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
- Department of Basic Mycobacteriology, Graduate School of Biomedical Science, Nagasaki University, Japan
| | - Yuta Hirano
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Kyota Shinfuku
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Hiroyuki Tashimo
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Akira Yamane
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
- JATA Fukujuji Hospital, Japan
| | - Shigeto Tohma
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
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Walters E, Demers AM, van der Zalm MM, Whitelaw A, Palmer M, Bosch C, Draper HR, Gie RP, Hesseling AC. Stool Culture for Diagnosis of Pulmonary Tuberculosis in Children. J Clin Microbiol 2017; 55:3355-65. [PMID: 28904186 DOI: 10.1128/JCM.00801-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/05/2017] [Indexed: 12/13/2022] Open
Abstract
Bacteriological confirmation of Mycobacterium tuberculosis is achieved in the minority of young children with tuberculosis (TB), since specimen collection is resource intensive and respiratory secretions are mostly paucibacillary, leading to limited sensitivity of available diagnostic tests. Although molecular tests are increasingly available globally, mycobacterial culture remains the gold standard for diagnosis and determination of drug susceptibility and is more sensitive than molecular methods for paucibacillary TB. We evaluated stool culture as an alternative to respiratory specimens for the diagnosis of suspected intrathoracic TB in a subgroup of 188 children (median age, 14.4 months; 15.4% HIV infected) enrolled in a TB diagnostic study at two local hospitals in Cape Town, South Africa. One stool culture was compared to overall bacteriological confirmation by stool Xpert and by Xpert and culture of multiple respiratory specimens. After decontamination/digestion with NALC (N-acetyl-l-cysteine)-NaOH (1.25%), concentrated fluorescent smear microscopy, Xpert MTB/RIF, and liquid culture were completed for all specimens. Culture contamination of stool specimens was high at 41.5%. Seven of 90 (7.8%) children initiating TB treatment were stool culture positive for M. tuberculosis. Excluding contaminated cultures, the sensitivity of stool culture versus confirmed TB was 6/25 (24.0%; 95% confidence interval [CI] = 9.4 to 45.1%). In addition, stool culture detected TB in 1/93 (1.1%) children with “unconfirmed TB.” Testing the same stool by Xpert increased sensitivity to 33.3% (95% CI = 18.0 to 51.8%). In conclusion, stool culture had low sensitivity for M. tuberculosis detection in children with intrathoracic TB. Reducing culture contamination through improved laboratory protocols may enable more reliable estimates of its diagnostic utility.
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Abaye GE, Abebe T, Worku A, Tolessa D, Ameni G, Mihret A. Detection of Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary tuberculosis. PLoS One 2017; 12:e0177529. [PMID: 28542255 PMCID: PMC5438117 DOI: 10.1371/journal.pone.0177529] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 04/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background The impact of tuberculosis (TB) is exacerbated in Africa because of the human immunodeficiency virus (HIV) pandemic. Pulmonary tuberculosis (PTB) diagnosis is difficult in HIV-infected patients and negative sputum results are more common which leads to diagnostic delay and increases morbidity and mortality. Extra-pulmonary samples such as stool may be easier to obtain and our approach may therefore significantly improve PTB detection in people living with HIV. Objective To detect Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary TB. Method A total of 117 HIV-infected individuals from three public health facilities in Addis Ababa, Ethiopia were enrolled consecutively in the study. Paired morning sputum and stool samples were simultaneously collected from anti-retroviral therapy (ART) naïve individuals living with HIV and suspected for PTB. The diagnostic accuracy of the smear microscopy, culture and region of difference (RD)9–based polymerase chain reaction (PCR) in stool was compared with the accuracy of sputum testing. Chi-square test and kappa value were used to compare different method used. Results Sputum culture positivity for mycobacteria was confirmed in 33(28.2%) of the study subjects. Of 33 individuals positive for sputa culture, 10 individuals were observed to be stools culture positive. Of the 84 individuals negative for mycobacteria by sputum culture, three (3.6%) were stool culture positive and thus, the sensitivity and agreement between stool culture as compare to sputum culture were 30.3% and 0.33, respectively. Of 117 individuals, 11(9.4%) were sputum smear positive and of 11 sputum smear positive three were also stool smear positive. While of the 106 sputum smear negative individuals’, only one was stool smear positive resulting in 12.1% sensitivity and 0.18 agreements against sputum culture. On the other hand, the sensitivity of RD9-based PCR directly on stool was 69.7% by considering sputum culture as a reference standard. Moreover, RD9-based PCR directly on sputum detected 7(6.0%) individuals who were sputum culture negative for M. tuberculosis. Conclusion M. tuberculosis was detected in stool of individuals living with HIV who were negative for sputum smear microscopy and culture. Hence, examination of stool samples alongside with sputum samples increases the detection of PTB in individuals living with HIV.
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Affiliation(s)
- Gizaw E. Abaye
- Department of Medical Laboratory Science, College of Health Sciences, Arsi University, Asella, Ethiopia
- * E-mail:
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adane Worku
- Aklilu Lemma Institute of Patho-biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Debela Tolessa
- Department of Biomedical Science, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Patho-biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Okumu A, McCarthy K, Orwa J, Williamson J, Musau S, Alexander H, Cavanaugh S, Modi S, Cain K. Comparison of Mycobacterium tuberculosis complex Yield and Contamination Rates using Lowenstein-Jensen with and without Antibiotics in Western Kenya. J Med Sci Clin Res 2017; 5:10.18535/jmscr/v5i8.86. [PMID: 35979512 PMCID: PMC9380436 DOI: 10.18535/jmscr/v5i8.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND While molecular methods have been recently endorsed for diagnosis of tuberculosis (TB), mycobacterial culture remains the gold standard. Lowenstein-Jensen (LJ) is often used for the cultivation of Mycobacterium tuberculosis complex (MTBC); however contamination often renders a subset of cultures useless. We compared the MTBC yield and contamination rate of processed sputum inoculated on LJ with antibiotics (LJ PACT) to LJ without antibiotics (LJ). METHODOLOGY Sputum samples were obtained from people living with HIV enrolled in a TB screening study in western Kenya, processed using NALC/NaOH-Na citrate, then inoculated on LJ PACT and LJ media. Cultures were evaluated weekly with growth identified as acid-fast bacilli by Ziehl-Neelsen bright-field microscopy. MTBC and nontuberculous mycobacteria (NTM) were identified by immunochromatographic and line probe assays. RESULTS A total of 700 sputum samples were cultured on both LJ PACT and LJ between March and June 2012. Of those cultured on LJ PACT, 29 (4.1%) grew MTBC, 613 (87.6%) were negative, 12 (1.7%) grew NTM, and 46 (6.6%) were contaminated; on LJ, 28 (4%) grew MTBC, 553 (79%) were negative, 9 (1.3%) grew NTM, and 110 (15.7%) were contaminated. The difference in contamination on LJ PACT and LJ was statistically significant (p<0.0001), while the difference in MTBC growth was not (p=0.566).
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Affiliation(s)
- A Okumu
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - K McCarthy
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
| | - J Orwa
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - J Williamson
- Division of Parasitic Diseases and Malaria (DPDM), CDC, Atlanta, GA
| | - S Musau
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - H Alexander
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
| | - S Cavanaugh
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
| | - S Modi
- Division of Global HIV/AIDS (DGHA), Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - K Cain
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
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Chiappini E, Lo Vecchio A, Garazzino S, Marseglia GL, Bernardi F, Castagnola E, Tomà P, Cirillo D, Russo C, Gabiano C, Ciofi D, Losurdo G, Bocchino M, Tortoli E, Tadolini M, Villani A, Guarino A, Esposito S. Recommendations for the diagnosis of pediatric tuberculosis. Eur J Clin Microbiol Infect Dis 2016; 35:1-18. [PMID: 26476550 DOI: 10.1007/s10096-015-2507-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 10/07/2015] [Indexed: 01/10/2023]
Abstract
Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease.
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Abstract
BACKGROUND Tuberculosis (TB) remains a major contributor to morbidity and mortality in HIV-positive individuals, causing 1.1 million incident cases and 0.32 million deaths in 2012. Diagnosis of TB is particularly challenging in HIV-coinfected individuals, due to a high frequency of smear-negative disease, atypical presentations, and extrapulmonary TB. OBJECTIVE The aim of this article was to review the current literature on molecular diagnostics for TB with an emphasis on the performance of these diagnostic tests in the HIV-positive population. METHODS We searched the PubMed database using at least one of the terms TB, HIV, diagnostics, Xpert MTB/RIF, nucleic acid amplification tests, drug susceptibility testing, RNA transcription, and drew on World Health Organization publications. FINDINGS With increased focus on reducing TB prevalence worldwide, a new set of tools for diagnosing the disease have emerged. Molecular tools such as Xpert MTB/RIF and line-probe assays are now in use or are being rolled out in many regions. The diagnostic performance of these and other molecular assays are discussed here as they pertain to the HIV-positive population. CONCLUSIONS Molecular diagnostics offer a useful addition and at times, alternative, to traditional culture methods for the diagnosis of TB. However, most of these tests suffer from decreased accuracy in the HIV-positive population.
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Jonnalagadda S, LaCourse SM, Otieno P, Lohman-Payne B, Maleche-Obimbo E, Cranmer LM, John-Stewart GC. Incidence and correlates of tuberculosis IGRA conversion among HIV-infected postpartum women. Int J Tuberc Lung Dis 2016; 19:792-8. [PMID: 26056103 DOI: 10.5588/ijtld.14.0878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined. OBJECTIVE To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB. DESIGN We used data and cryopreserved peripheral blood mononuclear cells from a historical cohort of HIV-infected women enrolled at 32 weeks' gestation and followed for 1 year postpartum between 1999 and 2005. RESULTS Of 89 women initially IGRA-negative during pregnancy, 11 (12.4%) became positive, 53 (59.5%) remained negative and 25 (28.1%) were indeterminate at 1 year postpartum. Mean interferon-gamma (IFN-γ) response among converters increased from ~1 to >50 spot-forming cells/well (P = 0.015). IGRA conversion was significantly associated with partner HIV infection, flush toilets, maternal illness and cough during follow-up, but not maternal CD4 count or HIV viral load. CONCLUSION The high rates of IGRA conversion seen among HIV-infected postpartum women in our study are similar to those of other groups at high risk for M. tuberculosis infection. This has important implications for M. tuberculosis infection screening strategies and provision of preventive therapy for the health of women and their infants.
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Affiliation(s)
- S Jonnalagadda
- Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - S M LaCourse
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - P Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - B Lohman-Payne
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya; Institute for Immunology and Informatics and Department of Cell and Molecular Biology, University of Rhode Island, Providence, Rhode Island, USA
| | | | - L M Cranmer
- Emory School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Disease, Atlanta, Georgia, USA
| | - G C John-Stewart
- Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA
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12
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Marcy O, Ung V, Goyet S, Borand L, Msellati P, Tejiokem M, Nguyen Thi NL, Nacro B, Cheng S, Eyangoh S, Pham TH, Ouedraogo AS, Tarantola A, Godreuil S, Blanche S, Delacourt C. Performance of Xpert MTB/RIF and Alternative Specimen Collection Methods for the Diagnosis of Tuberculosis in HIV-Infected Children. Clin Infect Dis 2016; 62:1161-1168. [PMID: 26908804 DOI: 10.1093/cid/ciw036] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/22/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The diagnosis of tuberculosis in human immunodeficiency virus (HIV)-infected children is challenging. We assessed the performance of alternative specimen collection methods for tuberculosis diagnosis in HIV-infected children using Xpert MTB/RIF (Xpert). METHODS HIV-infected children aged ≤13 years with suspected intrathoracic tuberculosis were enrolled in 8 hospitals in Burkina Faso, Cambodia, Cameroon, and Vietnam. Gastric aspirates were taken for children aged <10 years and expectorated sputum samples were taken for children aged ≥10 years (standard samples); nasopharyngeal aspirate and stool were taken for all children, and a string test was performed if the child was aged ≥4 years (alternative samples). All samples were tested with Xpert. The diagnostic accuracy of Xpert for culture-confirmed tuberculosis was analyzed in intention-to-diagnose and per-protocol approaches. RESULTS Of 281 children enrolled, 272 (96.8%) had ≥1 specimen tested with Xpert (intention-to-diagnose population), and 179 (63.5%) had all samples tested with Xpert (per-protocol population). Tuberculosis was culture-confirmed in 29/272 (10.7%) children. Intention-to-diagnose sensitivities of Xpert performed on all, standard, and alternative samples were 79.3% (95% confidence interval [CI], 60.3-92.0), 72.4% (95% CI, 52.8-87.3), and 75.9% (95% CI, 56.5-89.7), respectively. Specificities were ≥97.5%. Xpert combined on nasopharyngeal aspirate and stool had intention-to-diagnose and per-protocol sensitivities of 75.9% (95% CI, 56.5-89.7) and 75.0% (95% CI, 47.6-92.7), respectively. CONCLUSIONS The combination of nasopharyngeal aspirate and stool sample is a promising alternative to methods usually recommended by national programs. Xpert performed on respiratory and stools samples enables rapid confirmation of tuberculosis diagnosis in HIV-infected children. CLINICAL TRIALS REGISTRATION The ANRS (Agence Nationale de Recherche sur le Sida) 12229 PAANTHER (Pediatric Asian African Network for Tuberculosis and HIV Research) 01 study is registered at ClinicalTrials.gov (NCT01331811).
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Affiliation(s)
- Olivier Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,University of Bordeaux, Centre INSERM U1219, France
| | - Vibol Ung
- TB/HIV Department, National Pediatric Hospital.,University of Health Sciences, Phnom Penh, Cambodia
| | - Sophie Goyet
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Mathurin Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | | | - Boubacar Nacro
- Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Sokleaph Cheng
- Mycobacteriology Laboratory, Medical Laboratory Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sara Eyangoh
- Service de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | | | | | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sylvain Godreuil
- Département de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Montpellier, Hôpital Arnaud de Villeneuve.,INSERM U1058, Montpellier
| | | | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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13
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Kokuto H, Sasaki Y, Yoshimatsu S, Mizuno K, Yi L, Mitarai S. Detection of Mycobacterium tuberculosis (MTB) in Fecal Specimens From Adults Diagnosed With Pulmonary Tuberculosis Using the Xpert MTB/Rifampicin Test. Open Forum Infect Dis 2015; 2:ofv074. [PMID: 26125035 PMCID: PMC4462888 DOI: 10.1093/ofid/ofv074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022] Open
Abstract
We performed a proof-of-concept study using the Xpert MTB/RIF test for the detection of Mycobacterium tuberculosis from fecal samples. The overall sensitivity was 85.7% (95% CI; 73.8 – 93.6%) and the specificity was 100% (95% CI; 86.2–100). Background. The Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) is a fully automated diagnostic test that allows for the detection of MTB including its RIF resistance. Although the test is used for the diagnosis of tuberculosis (TB) in sputum samples worldwide, studies using fecal specimens are scarce. We therefore evaluated the efficacy of the Xpert MTB/RIF test for detection of MTB in fecal specimens obtained from adult pulmonary TB patients, confirmed by culture and/or molecular diagnostic methods. Methods. We conducted a retrospective case-control study to provide proof-of-concept regarding the efficacy of the Xpert MTB/RIF test using fecal samples for diagnosing pulmonary TB via detection of MTB in adult patients (≥20 years) at the Fukujuji Hospital in Tokyo, Japan. Results. Fecal specimens were obtained from 56 active pulmonary TB patients (including 48 sputum smear-positive and 8 sputum smear-negative patients), 10 non-TB patients (including 4 Myocobacterium avium complex infections), and 27 healthy individuals who were exposed to active pulmonary TB patients. The sensitivity of the fecal Xpert MTB/RIF was 100% (81.7%–100%) for detection of MTB in specimens from sputum smear-positive (1+ to 3+) patients, 81.0% (58.1%–94.6%) in specimens from sputum smear scanty positive patients, and 50.0% (15.7%–84.3%) in specimens from sputum smear-negative patients. Meanwhile, each of the fecal specimens from the non-TB group was negative for MTB (specificity 100%; 95% confidence interval, 86.2–100). Conclusions. The fecal Xpert MTB/RIF test could detect MTB in a large proportion of smear-positive pulmonary TB patients, without frequent false-positive results at a TB referral hospital in Japan.
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Affiliation(s)
| | | | | | - Kazue Mizuno
- Clinical Microbiology , Fukujuji Hospital, Japan Anti-Tuberculosis Association , Tokyo
| | - Lina Yi
- Departments of Respiratory Medicine ; Basic Mycobacteriology, Graduate School of Biomedical Science , Nagasaki University , Japan
| | - Satoshi Mitarai
- Mycobacterium Reference and Research , Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association , Tokyo ; Basic Mycobacteriology, Graduate School of Biomedical Science , Nagasaki University , Japan
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Yin N, Delord M, Giovanni A, del Grande J, Drancourt M, Brouqui P, Lagier JC. Laryngeal tuberculosis diagnosed by stool sample cultures: a case report. J Med Case Rep 2015; 9:74. [PMID: 25886183 PMCID: PMC4381499 DOI: 10.1186/s13256-015-0548-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/18/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Laryngeal tuberculosis is a rare and often misdiagnosed disease. Its diagnosis is based on the association of a laryngeal lesion and the microbiological detection of Mycobacterium tuberculosis. Stool cultures have recently been described as a useful tool in the diagnosis of atypical forms of tuberculosis. In this report, we describe the first case in the literature of laryngeal tuberculosis diagnosed by culture of stool samples. Case presentation A 41-year-old French Caucasian man was admitted to our hospital for dysphonia of 3 months’ evolution. A laryngeal biopsy was performed because of suspicion of carcinoma. He had no clinical signs of tuberculosis. The biopsy showed a caseating granuloma suggestive of laryngeal tuberculosis. The diagnosis was finally confirmed by stool cultures, whereas sputum cultures remained sterile for M. tuberculosis. Conclusions This case confirms the importance of stool cultures in the diagnosis of tuberculosis, especially for patients with uncommon presentations.
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Affiliation(s)
- Nicolas Yin
- Assistance Publique-Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015, Marseille, France.
| | - Marion Delord
- Assistance Publique-Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015, Marseille, France.
| | - Antoine Giovanni
- Service d'ORL et de chirurgie cervico-faciale, CHRU La Timone, 264, rue Saint-Pierre, 13385, Marseille, cedex 05, France.
| | - Jean del Grande
- Service d'Anatomo-pathologie, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France.
| | - Michel Drancourt
- Aix Marseille Université, URMITE, UMR63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.
| | - Philippe Brouqui
- Assistance Publique-Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015, Marseille, France. .,Aix Marseille Université, URMITE, UMR63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.
| | - Jean-Christophe Lagier
- Assistance Publique-Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015, Marseille, France. .,Aix Marseille Université, URMITE, UMR63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.
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Franck C, Seddon JA, Hesseling AC, Schaaf HS, Skinner D, Reynolds L. Assessing the impact of multidrug-resistant tuberculosis in children: an exploratory qualitative study. BMC Infect Dis 2014; 14:426. [PMID: 25084990 PMCID: PMC4127187 DOI: 10.1186/1471-2334-14-426] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the prevalence of multidrug-resistant (MDR) tuberculosis (TB) is high among children in the Western Cape of South Africa, the psychosocial implications of treatment for children with MDR-TB remain poorly understood. We sought to explore how MDR-TB and its treatment impact children on an individual, familial, and social level. METHODS Semi-structured interviews were conducted with 20 children and caregivers purposively sampled from a prospective clinical cohort of children. The sample was stratified by age at the start of treatment (children >10 years, and 5-10 years). Caregiver proxy interviews were conducted with younger children, supplemented with child interviews; older children were interviewed directly, supplemented with caregiver proxy interviews. Data were analysed using grounded theory. RESULTS Findings revealed pill volume and adverse effects produced significant physical, psychological and academic disturbances in children. Adverse effects related to the medication were important obstacles to treatment adherence. While there appear to be no long-lasting effects in younger children, a few older children showed evidence of persisting internalised stigma. Caregivers suffered important treatment-related financial and psychological costs. Community support, notably through the continued involvement of children in strong social networks, promoted resilience among children and their families. CONCLUSIONS We found that the current treatment regimen for childhood MDR-TB has significant psychological, academic, and financial impacts on children and their families. There is a need for psychosocial support of children and caregivers to mitigate the negative effects of community stigma, and to manage the stressors associated with chronic illness.
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Affiliation(s)
- Caroline Franck
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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