Use of Xpert for the diagnosis of pulmonary tuberculosis in severely malnourished hospitalized Malawian children.
| Title: | Use of Xpert for the diagnosis of pulmonary tuberculosis in severely malnourished hospitalized Malawian children. |
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| Authors: | LaCourse SM; From the *Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA; †UNC Project, Lilongwe, Malawi; ‡Department of Pediatrics, Baylor College of Medicine, Houston, TX; §University of North Carolina, Chapel Hill, NC; ¶Botswana-UPenn Partnership, Gaborone, Botswana; ‖Division of Pulmonology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; and **Department of Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.; Chester FM; Preidis G; McCrary LM; Arscott-Mills T; Maliwichi M; James G; McCollum ED; Hosseinipour MC |
| Source: | The Pediatric infectious disease journal [Pediatr Infect Dis J] 2014 Nov; Vol. 33 (11), pp. 1200-2. |
| Publication Type: | Comparative Study; Journal Article; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Williams & Wilkins Country of Publication: United States NLM ID: 8701858 Publication Model: Print Cited Medium: Internet ISSN: 1532-0987 (Electronic) Linking ISSN: 08913668 NLM ISO Abbreviation: Pediatr Infect Dis J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Baltimore, Md. : Williams & Wilkins, c1987- |
| MeSH Terms: | Child Nutrition Disorders/*complications ; Mycobacterium tuberculosis/*genetics ; Polymerase Chain Reaction/*methods ; Tuberculosis, Pulmonary/*diagnosis; Malawi/epidemiology ; Sputum/microbiology ; Tuberculosis, Pulmonary/complications ; Tuberculosis, Pulmonary/epidemiology ; Child, Preschool ; Hospital Mortality ; Hospitalization ; Humans ; Infant ; Microscopy ; Prevalence ; Prospective Studies ; Severity of Illness Index |
| Abstract: | Background: Pulmonary tuberculosis contributes to increased morbidity and mortality in severely malnourished children in endemic settings. Despite high clinical suspicion, few tuberculosis prevalence estimates exist in malnourished African children. Diagnostics such as Xpert MTB/RIF may help to determine pulmonary tuberculosis prevalence, however its performance in severely malnourished children is largely unknown.; Methods: We conducted a prospective observational study evaluating Xpert compared to smear microscopy and liquid culture on induced sputums among severely malnourished children (aged 6 to 60 months) at Kamuzu Central Hospital in Lilongwe, Malawi. From February 1 to May 30, 2012, children who met World Health Organization 2006 guidelines for severe acute malnutrition were evaluated using clinical symptoms, tuberculin skin tests, chest radiographs, and induced sputums. National Institute of Health (NIH) consensus case definitions were used to estimate tuberculosis prevalence.; Results: Three hundred severely malnourished children (median age 18.5 months, IQR 12.1-25.6) had one induced sputum performed; 295 (98.3%) received two. Fifty-two (17.6%) were HIV-infected. Over 25% had tuberculosis exposure with 48/297 (16.2%) reporting contact and 40/287 (13.9%) with positive TST. Two (0.7%) patients had confirmed tuberculosis by Xpert and culture, but only one had positive smear microscopy. Twenty (6.7%) patients fulfilled probable and 97 (66%) met possible tuberculosis NIH case definitions. Overall mortality was 9.7%.; Conclusions: Microbiologic confirmation likely underestimates the prevalence of pulmonary tuberculosis in severely malnourished children. In our study, Xpert on induced sputums did not increase case finding. Future studies are needed using Xpert among targeted groups of severely malnourished children and on non-sputum specimens. |
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| Grant Information: | T32 HL072748-11 United States HL NHLBI NIH HHS; T32 AI007140 United States AI NIAID NIH HHS; T32 HL072748 United States HL NHLBI NIH HHS; R24 TW007988 United States TW FIC NIH HHS; P30 AI050410 United States AI NIAID NIH HHS |
| Entry Date(s): | Date Created: 20141101 Date Completed: 20151028 Latest Revision: 20220309 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC4217085 |
| DOI: | 10.1097/INF.0000000000000384 |
| PMID: | 25361410 |
| Database: | MEDLINE |
Comparative Study; Journal Article; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't