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Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
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Stool-based Xpert testing for diagnosis of TB in children and critically ill adults

W Mwanza1, M Lutinala2, K Mundia3

  • 1Ministry of Health, Lusaka, Zambia;, USAID-STAR Project, Washington DC, USA.

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|February 1, 2025
PubMed

Insights

Stool-based Xpert MTB/RIF Ultra testing significantly improved tuberculosis diagnosis in Zambian children, increasing case notifications and confirmation rates. This method offers a vital alternative for children unable to provide sputum or gastric aspirate samples.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Diagnostics

Background:

  • Tuberculosis (TB) diagnosis in children, especially in resource-limited settings, presents challenges due to difficulties in sample collection.
  • Sputum and gastric aspirate (GA) are conventional samples, but not always feasible for pediatric TB diagnosis.
  • Xpert MTB/RIF Ultra (Xpert) is a rapid molecular test for TB detection.

Purpose of the Study:

  • To evaluate the routine implementation and impact of stool-based Xpert MTB/RIF Ultra testing for diagnosing childhood TB in Zambia.
  • To assess the utility of stool samples as an alternative to sputum or GA for Xpert testing in children and critically ill adults.

Main Methods:

  • Method validation comparing Xpert results from stool, sputum, and GA specimens.
  • Review of 18 months of routine implementation data for stool-based Xpert testing.
  • Analysis of childhood TB notifications and bacteriological confirmation rates before and after implementation.

Main Results:

  • Method validation showed 98.0% agreement between Xpert results on stool and conventional samples.
  • Over 18 months, 16,210 stool samples identified 157 TB cases in children and 45 in critically ill adults.
  • In children aged 0-4 years, stool testing volume significantly exceeded GA testing (10,288 vs. 2,459).
  • Childhood TB notifications rose by 30% and bacteriological confirmation by 53% in 2021 compared to 2020.

Conclusions:

  • Routine stool-based Xpert testing enhances access to TB diagnosis for children unable to produce sputum or undergo GA collection.
  • The implementation led to increased bacteriological confirmation of TB in children.
  • This approach also facilitated rapid testing for critically ill adults with sputum expectoration difficulties.

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