A systematic review and meta-analysis of the Alliance4TB stool support the use of Xpert Ultra test on stool samples to diagnose tuberculosis in children. he studyled by ISGlobal, a center promoted by the “la Caixa” Foundation, has been published in The Lancet Microbe.
The tuberculosis (TB) is difficult to diagnose in children due to the nonspecificity of the symptoms and the difficulty of obtaining respiratory samples that contain enough bacteria for confirmation. This delay in diagnosis can cause serious health problems and even death. In an effort to improve tuberculosis detection in this population, the scientific community is exploring the use of more accessible samples, such as stool, for molecular testing.
The ISGlobal doctoral student Lucia Carratala and an international team of experts from the EDCTP-funded Taburete4TB project conducted a systematic review and meta-analysis to examine the efficacy of molecular tests from stooland the way to process these, for the diagnosis of tuberculosis in children. The analysis included data from 35 studies (a total of 6,562 children) published between 2000 and 2023. The authors compared the detection of DNA from Mycobacterial tuberculosis in feces with traditional microbiological tests from other samples, or clinical diagnosis.
“It is about the most up-to-date systematic review on this topicwith a large number of studies that use Preventive and Epidemiology at the Clínic Barcelona hospital and coordinator of the Taburete4TB consortium. .
An effective and easier way to confirm tuberculosis.
The results show that the Xpert MTB/RIF and Xpert Ultra molecular tests achieved promising results when used on stool samples. Xpert Ultra, in particular, identified about 73% of children with bacteriological confirmation by respiratory samples. When tests based on respiratory samples were negative, the addition of this molecular test increased bacteriological confirmation by 39%.
Furthermore, the use of simplified methods to process stool samples without the need for a centrifuge did not affect – and often improved – the performance of molecular tests. these The results demonstrate that Xpert Ultra in these provides an easier and more effective way to confirm tuberculosis in the child population.especially when it is difficult to obtain respiratory samples.
«The WHO guidelines have recently included molecular tests from feces as a valid tool to diagnose tuberculosis in minors. Our study further supports this approach by providing new evidence on the diagnostic accuracy of Xpert Ultra in stool samples,” says Carratalà, who conducted this study with the support of the European Society for Pediatric Infectious Diseases. Furthermore, the adoption of this test by several African and Asian countries supports its feasibility and acceptability in high-burden countries.
The authors conclude that the use of Ultra on stool samples has great potential for routine TB testing in minors and could significantly improve early diagnosis and treatment, potentially saving many young lives.
Reference
Carratalà L, Munguambe S, Saavedra-Cervera B et al. Use of stool-based molecular tests for the diagnosis of pediatric tuberculosis: a systematic review and meta-analysis. lancet microbe. 2024. Doi:10.1016/j.lanmic.2024.100963
