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Published on: April 9, 2012
Stool Processing Methods for Xpert Ultra Testing in Childhood Tuberculosis: A Prospective, Multicountry Accuracy
Devan Jaganath1,2, Pamela Nabeta3, Mark P Nicol4
1Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, California, USA.
Centrifuge-free stool processing methods for childhood tuberculosis (TB) testing using Xpert Ultra were found to be acceptable and usable. Sensitivity was highest in culture-positive cases, showing potential for improved TB diagnosis in children.
Area of Science:
- Microbiology
- Infectious Diseases
- Pediatric Health
Background:
- Centrifuge-free methods for stool Xpert Ultra testing in childhood tuberculosis (TB) are emerging but lack comprehensive accuracy and usability data.
- Accurate diagnosis of TB in children is challenging due to non-specific symptoms and difficulties in sample collection.
Purpose of the Study:
- To evaluate the accuracy, acceptability, and usability of three centrifuge-free stool processing methods (Stool Processing Kit [SPK], Simple One-Step [SOS], Optimized Sucrose Flotation [OSF]) for Xpert Ultra testing in children with presumptive TB.
- To compare the performance of these methods against microbiological and composite reference standards.
Main Methods:
- A prospective study involving 607 children under 15 years old with presumptive TB across India, South Africa, and Uganda.
- Stool samples were processed using SPK, SOS, and OSF methods for Xpert Ultra testing.
- Accuracy was assessed against a microbiological reference standard (MRS) and a composite reference standard (CRS). Laboratory staff surveys evaluated method acceptability and usability.
Main Results:
- Sensitivities against the MRS ranged from 31.3% (OSF) to 38.6% (SOS), with high specificities (97.1%–98.2%).
- All methods were deemed acceptable and usable, with SOS noted as most feasible for peripheral facilities.
- Sensitivity improved significantly in culture-positive children (55.0%–77.3%) and increased when stool Xpert Ultra was added to sputum testing (0%–11.8% improvement).
Conclusions:
- Centrifuge-free stool processing methods for Xpert Ultra testing are acceptable and usable for childhood TB diagnosis.
- The methods demonstrated similar performance, with the highest sensitivity observed in culture-positive pediatric TB cases.
- These findings support the potential utility of these methods in resource-limited settings for improving TB detection in children.
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