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Updated: Jun 10, 2025
Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
Published on: April 9, 2012
Stool Xpert® MTB/RIF Ultra for TB diagnosis in children: experience from a national scale-up programme
S Kabir1, S Choudhury1, T Rahman1
1Progamme on Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Insights
Stool testing using Xpert MTB/RIF Ultra significantly improves pediatric pulmonary TB diagnosis. This approach identifies more cases, but diagnostic yield varies by symptoms, requiring careful evaluation for optimal resource use.
Area of Science:
- Microbiology
- Public Health
- Pediatric Infectious Diseases
Background:
- The World Health Organization recommends Xpert MTB/RIF Ultra (Ultra) for improved childhood pulmonary TB (PTB) diagnosis.
- Programmatic scale-up of stool testing using Ultra is crucial for enhancing PTB detection in children.
Purpose of the Study:
- To evaluate the effectiveness of stool testing with Xpert MTB/RIF Ultra for diagnosing pulmonary TB in children.
- To assess the programmatic implementation and diagnostic yield of stool Ultra testing across various healthcare facilities.
Main Methods:
- A stool-based diagnostic approach using Xpert MTB/RIF Ultra was implemented at 51 healthcare facilities in Bangladesh.
- Specimens from children (<15 years) with presumptive TB were tested, with TB diagnosis and treatment confirmed by physicians.
Main Results:
- Over 16,400 specimens were tested between March 2022 and December 2023, with a 5.3% positivity rate.
- A significant proportion (73.7%) of positive results were 'trace detected'.
- Positivity varied by age, sex, and presenting symptoms, with higher rates in females and specific symptom clusters.
Conclusions:
- Stool testing with Ultra offers a more effective method for diagnosing bacteriologically confirmed PTB in children.
- Diagnostic yield is influenced by presenting symptoms, emphasizing the need for judicious application of diagnostic resources.
Introduction:
We describe the programmatic scale-up of stool testing using Xpert® MTB/RIF Ultra (Ultra), as recommended by the WHO to improve childhood pulmonary TB (PTB) diagnosis.
Methods:
USAID's Alliance for Combating TB in Bangladesh Activity, in collaboration with the National TB Control Programme, is implementing a stool-based diagnostic approach at 51 healthcare facilities in Bangladesh to improve PTB detection. Specimens from children (<15 years) with presumptive TB were tested using 'stool Ultra' with routine TB diagnostics. Physicians confirmed TB diagnosis and provided treatment as per national guidelines.
Results:
Between March 2022 and December 2023, 16,429 specimens were tested, 871 (5.3%) were positive, and 642 (73.7%) showed 'trace detected' results. Positivity was significantly higher among females, and children presented with 'only cough ≥2 weeks', 'cough ≥2 weeks + weight loss', or 'fever ≥2 weeks, weight loss, fatigue + contact history'. Positivity was higher among '10-14 years old' children; however, 'trace detected' was highest among '5-9 years', followed by children aged '>2-<5 years' and '0-2 years'.
Conclusions:
Testing stools using Ultra provides a more effective way of diagnosing bacteriologically positive PTB in children. However, positivity varies with presenting symptoms/criteria, highlighting the need for careful diagnostic evaluation to ensure optimum use of limited diagnostic resources.
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