Use of Xpert MTB/RIF for diagnosis of pediatric tuberculosis in Indonesia

  • Rina Triasih
  • Amalia Setyati
  • Dwikisworo Setyowireni
  • Titik Nuryastuti
  • Rachma Dewi Isnaini Putri
  • Emi Rusdiyati
Keywords: Xpert MTB/RIF; tuberculosis; children

Abstract

Background The Xpert MTB/RIF assay demonstrated a better diagnostic value than sputum smear for TB in adults and children.

Objective To evaluate the use of Xpert MTB/RIF for TB diagnosis in children.

Methods We conducted a prospective study in Yogyakarta, Indonesia, involving 19 primary health centers (PHCs) and one provincial hospital. Children aged 0-14 years with suspected TB who visited the study sites were screened. Subjects underwent history-taking, physical examination, tuberculin skin test, chest X-ray, as well as sputum induction for Xpert MTB/RIF assay, sputum smear, and TB culture. The diagnosis of TB was made by doctors based on the results of investigations, as follows: certain TB (bacteriological confirmation), probable TB, and possible TB.

Results Of 80 subjects, 21 (26%) were diagnosed with TB disease (4 certain TB and 17 probable TB). Sputum induction was successfully performed in 79 children. None of the children had positive sputum smears. Mycobacterium tuberculosis was detected by Xpert MTB/RIF in 4 children, accounting for 5% of all children with suspected TB, or 19% among children with TB disease. The 4 Xpert MTB/RIF-positive subjects had severe TB disease and were rifampicin-sensitive.

Conclusion Xpert MTB/RIF may improve case finding among children with severe TB disease with negative sputum smear.

References

Marais BJ, Pai M. New approaches and emerging technologies in the diagnosis of childhood tuberculosis. Paediatr Respir Rev. 2007;8:124-33. DOI: 10.1016/j.prrv.2007.04.002.

Detjen AK, DiNardo AR, Leyden J, Steingart KR, Menzies D, Schiller I, et al. Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis. Lancet Respir Med. 2015;3:451-61. DOI: 10.1016/S2213-2600(15)00095-8.

WHO. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. Geneva, Switzerland: WHO; 2013.

WHO. Global tuberculosis report. Geneva: WHO; 2015.

Coghlan R, Gardiner E, Amanullah F, Ihekweazu C, Triasih R, Grzemska M, et al. Understanding market size and reporting gaps for paediatric TB in Indonesia, Nigeria and Pakistan: supporting improved treatment of childhood TB in the advent of new medicines. PLoS One. 2015;10:e0138323. DOI: 10.1371/journal.pone.0138323.

Lestari T, Probandari A, Hurtig AK, Utarini A. High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: a cross sectional study. BMC Public Health. 2011;11:784. DOI: 10.1186/1471-2458-11-784.

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;13:36-42. DOI: 10.1016/S1473-3099(12)70245-1.

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;9:e93776.

LaCourse SM, Chester FM, Preidis G, McCrary LM, Arscott-Mills T, Maliwichi M, et al. Use of Xpert for the diagnosis of pulmonary tuberculosis in severely malnourished hospitalized Malawian children. Pediatr Infect Dis J. 2014;33:1200-2. DOI: 10.1371/journal.pone.0093776.

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;11:819-24. DOI: 10.1016/S1473-3099(11)70167-0.

Pang Y, Wang Y, Zhao S, Liu J, Zhao Y, Li H. Evaluation of the Xpert MTB/RIF assay in gastric lavage aspirates for diagnosis of smear-negative childhood pulmonary tuberculosis. Pediatr Infect Dis J. 2014;33:1047-51.

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 Glob Health. 2013;1:e97-104. DOI: 10.1097/INF.0000000000000403.

Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Enarson DA, Beyers N. The bacteriologic yield in children with intrathoracic tuberculosis. Clin Infect Dis. 2006;42:e69-71. DOI: 10.1086/502652.

Geleta DA, Megerssa YC, Gudeta AN, Akalu GT, Debele MT, Tulu KD. Xpert MTB/RIF assay for diagnosis of pulmonary tuberculosis in sputum specimens in remote health care facility. BMC Microbiol. 2015;15:220. DOI: 10.1186/s12866-015-0566-6.

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 Tuberc Lung Dis. 2015;19:1091-7. DOI: 10.5588/ijtld.15.0228.

Pitchenik AE, Ganjei P, Torres A, Evans DA, Rubin E, Baier H. Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Am Rev Respir Dis. 1986;133:226-9.

Joel DR, Steenhoff AP, Mullan PC, Phelps BR, Tolle MA, Ho-Foster A, et al. Diagnosis of paediatric tuberculosis using sputum induction in Botswana: programme description and findings. Int J Tuberc Lung Dis. 2014;18:328-34. DOI: 10.5588/ijtld.13.0243.

Planting NS, Visser GL, Nicol MP, Workman L, Isaacs W, Zar HJ. Safety and efficacy of induced sputum in young children hospitalised with suspected pulmonary tuberculosis. Int J Tuberc Lung Dis. 2014;18:8-12. DOI: 10.5588/ijtld.13.0132.

Geldenhuys HD, Kleynhans W, Buckerfield N, Tameris M, Gonzalez Y, Mahomed H, et al. Safety and tolerability of sputum induction in adolescents and adults with suspected pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis. 2012;31:529-37. DOI: 10.1007/s10096-011-1344-5.

Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a p.rospective study. Lancet. 2005;365:130-4. DOI: 10.1016/S0140-6736(05)17702-2

WHO. Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2nd ed. Geneva: WHO; 2014.

Moore HA, Apolles P, de Villiers PJ, Zar HJ. Sputum induction for microbiological diagnosis of childhood pulmonary tuberculosis in a community setting. Int J Tuberc Lung Dis. 2011;15:1185-90. DOI: 10.5588/ijtld.10.0681.

Published
2020-07-17
How to Cite
1.
Triasih R, Setyati A, Setyowireni D, Nuryastuti T, Putri R, Rusdiyati E. Use of Xpert MTB/RIF for diagnosis of pediatric tuberculosis in Indonesia. PI [Internet]. 17Jul.2020 [cited 28Mar.2024];60(4):198-04. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2288
Section
Pediatric Respirology
Received 2019-09-02
Accepted 2020-07-17
Published 2020-07-17