Performance of stool-based molecular tests and processing methods for paediatric tuberculosis diagnosis: a systematic...

Area of Science:

• Pediatric infectious diseases
• Molecular diagnostics
• Tuberculosis research

Background:

• Global efforts focus on improving pediatric tuberculosis (TB) diagnosis using accessible biospecimens like stool.
• Accurate and timely diagnosis in children remains a challenge, necessitating novel approaches.

Purpose of the Study:

• To systematically review the accuracy of stool-based molecular tests for diagnosing TB in children.
• To assess the impact of pre-processing methods and study design on diagnostic performance.

Main Methods:

• A systematic review and meta-analysis of studies published between 2000 and 2024.
• Included children under 16 with presumptive TB, comparing stool molecular tests (Xpert MTB/RIF, Xpert Ultra) against microbiological or clinical diagnosis.
• Stratified analysis by stool processing methods and quantified the additional diagnostic yield of stool Xpert Ultra.

Main Results:

• Stool Xpert Ultra demonstrated higher sensitivity (0.73) compared to Xpert MTB/RIF (0.60) when using bacteriological confirmation as reference.
• Stool Xpert Ultra increased overall TB bacteriological confirmation by 38.6%.
• Centrifuge-free methods improved stool Xpert Ultra sensitivity (0.77) compared to non-centrifuge-free methods (0.61).

Conclusions:

• Stool-based Xpert Ultra is a valuable tool for pediatric TB diagnosis.
• It enhances bacteriological confirmation, even when other specimens are tested.
• Simplified processing methods show promise for improving diagnostic accuracy.