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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(03): 329-335
DOI: 10.1055/s-0042-1757721
Original Article

Evaluation of Xpert MTB/RIF Assay on Stool Samples for the Diagnosis of Pulmonary Tuberculosis among the Pediatric Population

Sangitha Jayagandan 
1   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Jitendra Singh 
2   Department of Translational Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Shivkumar Rashmi Mudliar
1   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Prem Shankar 
1   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Anand Kumar Maurya 
1   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Anvita Gupta Malhotra 
1   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Shikha Malik
3   Department of Paediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Shashank Purwar 
1   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Sarman Singh 
4   Former Director, All India Institute of Medical Sciences, Bhopal, India
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Abstract

Objective Microbiological confirmation of tuberculosis (TB) in pediatric cases is challenging due to its paucibacillary nature and difficulty in specimen collection. This study aimed to validate stool as an alternative sample for the diagnosis of pediatric pulmonary TB via Xpert MTB/RIF (Xpert) assay.

Materials and Methods This cross-sectional study included 75 pediatric patients up to 10 years of age with signs and symptoms suggestive of TB. From each recruited patient, pulmonary and stool samples were collected in a sterile container. The collected samples were subjected to Ziehl-Neelsen staining, BACTEC MGIT 960 culture (MGIT), Xpert, and in-house multiplex polymerase chain reaction for TB diagnosis.

Results About 13.33% (10/75) of the pulmonary samples and, of them, 50% (5/75) of the stool samples were positive by Xpert assay. The sensitivity and specificity of Xpert assay with stool and pulmonary samples were 50 (95% confidence interval [CI]: 18.71–81.29%) and 100% (95% CI: 94.48–100%), respectively.

Conclusion The Xpert assay on stool samples showed limited sensitivity and good specificity in the diagnosis of pulmonary TB. Therefore, it can be proposed as an alternative screening sample to diagnose TB in pediatric cases for which getting a respiratory sample is extremely difficult. However, further studies with greater number of samples and multiple baseline variables are required to support our findings. Strategies to optimize stool Xpert assay should be performed to enhance the sensitivity of this method to detect Mycobacterium tuberculosis in children.

Keywords

Xpert MTB/RIF assay - culture - multiplex PCR - stool sample - pediatric pulmonary tuberculosis

Authors' Contributions

J.S. was involved in performing the experiments, analysis of data, and writing and reviewing the manuscript. R.M. performed the experiments. P.S. edited and reviewed the manuscript. A.K. Maurya reviewed the manuscript. A.G.M. contributed to analysis of data and review of manuscript. S.M. was involved in analysis and interpretation of data and review of manuscript. S.P. was involved in conceptualization of the study, analysis, and interpretation of data, writing, and review of the manuscript. S.S. contributed to conceptualization of the study, interpretation of data, and review of the manuscript.


Ethical Approval

Ethical clearance for the study was obtained from the Institutional Human Ethics Committee (IHEC), AIIMS, Bhopal, Madhya Pradesh, India (Approval No: IHEC-LOP/2020/MD0055).




Publication History

Article published online:
20 October 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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