Stool Culture for Diagnosis of Pulmonary Tuberculosis in Children.
Stool Culture for Diagnosis of Pulmonary Tuberculosis in Children.
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DOI：
10.1128/jcm.00801-17
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发表时间：
2017-12
影响因子：
9.4
通讯作者：
Hesseling AC
中科院分区：
文献类型：
--
作者：
Walters E;Demers AM;van der Zalm MM;Whitelaw A;Palmer M;Bosch C;Draper HR;Gie RP;Hesseling AC
结核分枝杆菌的细菌学确认在少数患有结核病（TB）的幼儿中实现，因为标本采集是资源密集型的，并且呼吸道分泌物大多是少杆菌的，导致可用的诊断测试的敏感性有限。尽管全球越来越多地使用分子检测，但分枝杆菌培养仍然是诊断和确定药物敏感性的金标准，并且对于少杆菌结核病比分子方法更敏感。在南非开普敦的两家当地医院，我们对参加结核病诊断研究的188名儿童（中位年龄14.4个月，15.4% HIV感染）进行了粪便培养作为呼吸道标本诊断疑似胸内结核病的替代方法的评价。将一次粪便培养与粪便Xpert和Xpert与多份呼吸道标本培养的总体细菌学确认进行比较。用NALC（N-乙酰-L-半胱氨酸）-NaOH（1.25%）去污/消化后，对所有标本进行浓缩荧光涂片显微镜检查、Xpert MTB/RIF和液体培养。粪便标本的培养污染率高达41.5%。开始结核病治疗的90名儿童中有7名（7.8%）粪便培养为M阳性。结核排除污染培养物，粪便培养对确诊TB的敏感性为6/25（24.0%; 95%置信区间[CI] = 9.4 - 45.1%）。此外，粪便培养在1/93（1.1%）患有“未确诊结核病”的儿童中检出结核病。Xpert检测相同粪便的灵敏度增加至33.3%（95% CI = 18.0 - 51.8%）。结论：粪便培养对M.肺结核检测在儿童胸腔内结核。通过改进实验室方案减少培养物污染，可以更可靠地估计其诊断效用。
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.