Diagnosis of paediatric tuberculosis by cartridge based nucleic acid amplification test and its effectiveness as compared to the other conventional diagnostic methods

Authors

  • Jyotiranjan Champatiray Department of Pediatrics, SCB Medical College, Cuttack, Odisha, India,
  • G. Dharmaraj Patra Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20192013

Keywords:

Antitubercular therapy, Cartridge based nucleic acid amplification test, Mycobacteria growth indicator tube

Abstract

Background: Childhood TB constitutes 10-20% of all TB cases in high burden countries like India and accounting for 8-20% of TB related deaths. Diagnosis of TB in children is difficult. One test, CBNAAT which was recently endorsed by WHO has the potential to lead a revolution in diagnosis of active TB disease.

Methods: A cross sectional study in SCB MCH and SVPPGIP, Cuttack in all the suspected TB patients admitted during the period from January 2016 to October 2017.

Results: A total of 100 suspicious patients admitted to the Department of Pediatrics in SCB MCH and SVPPGIP during the study period. Of these 45 were diagnosed TB and rest others were diagnosed otherwise than TB. Diagnosis of TB was established on basis of Microscopy, CBNAAT, culture, biochemistry, cytology, clinical findings, neuroimaging, FNAC/biopsy, USG abdomen. Out of 45 TB patients 30 were CBNAAT positive taking the body fluid samples other than blood, urine and stool with a sensitivity of 66.7% and specificity of 100%. Out of 45 TB patients 14 were having ZN Smear positive taking the same fluid sample with a sensitivity of 31.1% and specificity of 100%. Whereas out of these 45 TB patients 32 were MGIT culture positive taking the same sample with a sensitivity of 71.1% and specificity of 100%. When diagnostic performances of CBNAAT and MGIT culture were compared, it was found to be statistically insignificant with a P value 0.54.

Conclusions: The CBNAAT is able to confirm a diagnosis of TB with 66.7% sensitivity and 100% specificity within 2 hours. We can use CBNAAT as a diagnostic method as it provides rapid result and simultaneous better sensitive result, it can be helpful in starting ATT in sick patients and also in outdoor patients.

References

World Health Organization. Global hepatitis report 2017. World Health Organization. 2017. Available at: https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/.

Ahmed T, Sobhan F, Ahmed AM, Banu S, Mahmood AM, Hyder KA, et al. Childhood tuberculosis: a review of epidemiology, diagnosis and management. Infect Dis J Pakistan. 2008;17(2):52-60.

Jereb JA, Kelly GD, Porterfield DS. The epidemiology of tuberculosis in children. Sem Pediatr Infect Dis. 1993;4:220-31.

Bloch A, Snider D. How much tuberculosis in children continue to be neglected? Am J Public Health.1986;76:14-15.

World Health Organisation. WHO endorses new rapid tuberculosis test, 2010. Available at: https://www.who.int/mediacentre/news/releases/2010/tb_test_20101208/en/.

Garg RK. Tuberculosis of the central nervous system. Postgraduate Med J. 1999;75(881):133-40.

Narayan S, Mahadevan S, Serane VT. Keith Edwards score for diagnosis of tuberculosis. Indian J Pediatr. 2003;70(6):467-9.

World Health Organisation. Score chart for the diagnosis of TB in children, TB: A clinical manual for South East Asia, WHO/TB/96.200(SEA), 1997. Available at: https://apps.who.int/iris/bitstream/handle/10665/63310/WHO_TB_96.200_SEA.pdf?sequence=1&isAllowed=y.

Bates M, O'Grady J, Maeurer M, Tembo J, Chilukutu L, Chabala C, et al. Assessment of the Xpert MTB/RIF assay for diagnosis of tuberculosis with gastric lavage aspirates in children in sub-Saharan Africa: a prospective descriptive study. Lancet Infect Dis. 2013;13(1):36-42.

Kulkarni S, Jadhav S, Khopkar P, Sane S, Londhe R, Chimanpure V, et al. GeneXpert HIV-1 quant assay, a new tool for scale up of viral load monitoring in the success of ART programme in India. BMC infectious diseases. 2017;17(1):506.

Detjen A, Dinardo A, Leyden J, Steingart KR, Xpert MTB/RIF assay for the diagnosis of pulmonary TB in children ;a systematic review and meta analysis. Lancet Respir Med. 2015;3(6):451-61.

Bunyasi EW, Tameris M, Geldenhuys H, Schmidt BM, Luabeya AK, Mulenga H, et al. Evaluation of Xpert® MTB/RIF assay in induced sputum and gastric lavage samples from young children with suspected tuberculosis from the MVA85A TB vaccine trial. PloS One. 2015;10(11):e0141623.

Duong TN, Ha DT, Nhan HT, Wolbers M, Nhu NT, Heemskerk D, et al. Prospective evaluation of GeneXpert for the diagnosis of HIV-negative pediatric TB cases. BMC Infect Dis. 2015;15(1):70.

Bholla M, Kapalata N, Masika E, Chande H, Jugheli L, Sasamalo M, et al. Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study. BMC Infect Dis. 2016;16(1):246.

Wang XW, Pappoe F, Huang Y, Cheng XW, Xu DF, Wang H, et al. Xpert MTB/RIF Assay for Pulmonary Tuberculosis and Rifampicin Resistance in Children: a Meta-Analysis. Clin Laboratory. 2015;61(11):1775-85.

Togun TO, Egere U, Sillah AK, Ayorinde A, Mendy F, Tientcheu L, et al. Contribution of Xpert® MTB/RIF to the diagnosis of pulmonary tuberculosis among TB-exposed children in the Gambia. Int J Tuberculosis Lung Dis. 2015;19(9):1091-7.

Chisti MJ, Graham SM, Duke T, Ahmed T, Ashraf H, Faruque AS, et al. A prospective study of the prevalence of tuberculosis and bacteraemia in Bangladeshi children with severe malnutrition and pneumonia including an evaluation of Xpert MTB/RIF assay. PloS One. 2014 2;9(4):e93776.

Zar HJ, Workman L, Isaacs W, Dheda K, Zemanay W, Nicol MP. Rapid diagnosis of pulmonary tuberculosis in African children in a primary care setting by use of Xpert MTB/RIF on respiratory specimens: a prospective study. Lancet Global Health. 2013;1(2):e97-104.

Sekkade MP, Wobudeya E, Joloba ML, Ssengooba W, Kisembo H, Bakeera-Kitaka S, et al. Evaluation of Xpert MTB/RIF for the diagnosis of childhood pulmonary TB in Uganda: a cross-sectional diagnostic study. BMC Infectious Dis. 2013;13(1):133.

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.

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Published

2019-04-30

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Original Research Articles