对使用替代标本（鼻咽抽吸物和粪便）诊断儿童胸内结核的Xpert MTB/RIF检测的多国评估：在马达加斯加、科特迪瓦和喀麦隆进行的一项前瞻性队列研究（结核病儿童项目）。

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2025-02-01 DOI:10.1016/j.ijid.2024.107366

Rindra Vatosoa Randremanana , Mathurin Tejiokem , Niaina Rakotosamimanana , Valérie Donkeng Donfack , Verlaine Bolyse Mbouchong , Mirella Randrianarisoa , Aina Harimanana , Jean Voisin Taguebue , Suzie Tetang Ndiang , Valère Itchy , Annick Robinson , Lovaniaina Ravelomanana , Mbola Rakotomahefa , Dina Ranoharison , Man-Koumba Soumahoro , Brigitte Gicquel , Raymond N'Guessan , Sara Eyangoh , Voahangy Rasolofo , Kathleen Victoir

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引用次数: 0

摘要

背景：儿童结核病（TB）的诊断仍然具有挑战性，因为标本的细菌数量少，难以获得合适的样本。使用鼻咽抽吸液（NPA）和粪便等替代样本，以及专家MTB/RIF检测，提供了有希望的改进。目的：本研究旨在评估Xpert MTB/RIF检测对马达加斯加、喀麦隆和科特迪瓦儿童NPA和粪便样本的诊断性能。方法：在这些国家首都的医院登记15岁以下疑似胸内结核的儿童。用于分析的样本包括标准标本（胃吸液或痰液）、NPA、粪便，以及附加的HIV血清学、TST检测和胸部x光片。我们使用一个复合参考标准来估计Xpert MTB/RIF测试与替代样品的准确性。结果：在分析的1146例儿童中，Xpert MTB/RIF对NPA的敏感性为58.3%，对粪便样本的敏感性为45.5%，特异性大于95%。Xpert MTB/RIF与替代样本的诊断性能没有根据年龄组或艾滋病毒状态而有所不同。结论：这些发现支持了世卫组织2022年关于在儿童结核病诊断中使用Xpert MTB/RIF替代样本的建议，强调了其在不同环境和艾滋病毒状态下的实用性。

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A multicountry evaluation of the Xpert MTB/RIF assay for the diagnosis of intrathoracic tuberculosis in children using alternative specimens (nasopharyngeal aspirate and stool): A prospective cohort study conducted in Madagascar, Ivory Coast and Cameroon (TB KIDS project)

Objectives

Tuberculosis (TB) diagnosis in children remains challenging due to the paucibacillary nature of specimens and the difficulty in obtaining suitable samples. The use of alternative samples like nasopharyngeal aspirate (NPA) and stools, alongside Xpert MTB/RIF testing, offers promising improvements. This study aimed to assess the diagnostic performance of the Xpert MTB/RIF test on NPA and stool samples for detecting intrathoracic TB in children from Madagascar, Cameroon, and Ivory Coast.

Methods

Children under 15 years with suspected intrathoracic TB were enrolled in hospitals in these countries’ capitals. Samples for analysis included standard specimens (gastric aspirate or sputum), NPA, stools, with additional HIV serology, tuberculin skin test tests, and chest X-rays. We used a composite reference standard to estimate the accuracy of the Xpert MTB/RIF test with alternative samples.

Results

Of 1146 children analyzed, the sensitivity of Xpert MTB/RIF was 58.3% for NPA and 45.5% for stool samples, with a high specificity of more than 95%. The diagnostic performance of Xpert MTB/RIF with alternative samples did not differ according to age group or HIV status.

Conclusions

The findings support the World Health Organization's recommendation for using Xpert MTB/RIF with alternative samples in childhood TB diagnosis, underscoring its utility across different settings and HIV statuses.

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.