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Stool-Based Molecular Tuberculosis Treatment Monitoring: A Faster Means for Detecting Persistent Mycobacteria
Clement Gascua Adu Gyamfi1,2,3,4, Abigail Seeger1, Durbbin Mulengwa1,2
1Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Open Forum Infectious Diseases
|August 13, 2025
Summary
Stool quantitative PCR offers a faster, more accessible method for monitoring tuberculosis (TB) treatment, correlating with sputum culture and identifying patients at risk for drug resistance and persistent infection.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Diagnostics
Background:
- Tuberculosis (TB) treatment monitoring lacks rapid biomarkers for predicting outcomes.
- Symptom screening and culture methods have limitations in speed and clinical relevance.
- There is a need for accessible and timely biomarkers for effective TB management.
Purpose of the Study:
- To assess the potential of stool-based quantitative polymerase chain reaction (qPCR) for monitoring TB treatment.
- To compare stool qPCR results with sputum culture, symptoms, drug resistance, and treatment outcomes.
- To evaluate stool qPCR as a biomarker for predicting TB treatment response.
Main Methods:
- Prospective study of 231 participants with confirmed TB across Eswatini, Tanzania, and Mozambique.
- Quantitative stool qPCR was performed and compared to sputum culture.
- Analysis included correlation with drug resistance, persistent symptoms, and WHO TB outcomes.
Main Results:
- Stool qPCR strongly correlated with sputum culture (r=0.79, P<.001).
- Stool collection success rate was >90%, while sputum collection decreased significantly over time.
- Stool qPCR identified patients with drug resistance and those at risk for persistent culture positivity at 2 months.
Conclusions:
- Stool-based TB treatment monitoring using qPCR is a viable alternative to sputum culture.
- It offers faster results, uses a more accessible specimen, and aids in identifying high-risk patients.
- Quantitative bacillary burden tests did not predict symptom resolution or death.
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