The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers

• Published in: Revista da Sociedade Brasileira de Medicina Tropical Vol. 53; p. e20200205
• Main Authors: Aurilio, Rafaela Baroni, Luiz, Ronir Raggio, Land, Marcelo Gerardin Poirot, Cardoso, Claudete Aparecida Araújo, Kritski, Afrânio Lineu, Sant'Anna, Clemax Couto
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Medicina Tropical - SBMT 01.01.2020; Sociedade Brasileira de Medicina Tropical (SBMT)
• Subjects: Adolescent; Adult; Brazil - epidemiology; Child; Child, Preschool; Cross-Sectional Studies; Diagnosis; Humans; Infant; Infant, Newborn; Major; Mycobacterium tuberculosis - genetics; Mycobacterium tuberculosis - isolation & purification; Polymerase chain reaction; Referral and Consultation; Sputum - microbiology; TROPICAL MEDICINE; Tuberculosis; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - epidemiology; Young Adult; Brazil; Polymerase chain reaction; Tuberculosis; Diagnosis
• DOI: 10.1590/0037-8682-0205-2020
• ISSN: 0037-8682; 1678-9849

The diagnostic accuracy of Xpert MTB/RIF (Xpert) in pulmonary tuberculosis (PTB) in children is lower than in adults. In Brazil, the diagnosis of PTB is based on a diagnostic score system (DSS). This study aims to study the role of Xpert in children and adolescents with PTB symptoms. cross-sectional study was conducted in 3 referral centers to TB. Children and adolescents (0-19 years old) whose respiratory samples were submitted to Xpert were included. Statistical analysis (bivariate and logistic regression) to assess the simultaneous influence of TB-related variables on the occurrence of Xpert detectable in TB cases was done. To evaluate the agreement or disagreement between Xpert results with acid-fast bacillus (AFB) and cultures, κ method was used (significancy level of 5%). Eighty-eight patients were included in the study and PTB occurred in 43 patients (49%) and Xpert was detectable in 21 patients (24%). Adolescents and positive culture results were independent predictive variables of Xpert positivity. DSS sensitivity compared with the final diagnosis of TB was 100% (95% CI, 88.1-100%), specificity was 97.2% (95% CI, 85.5-99.9%). The accuracy of the method was 98.5% (95% CI, 91.7-99.9%). Xpert contributed to diagnosis in 9% of patients with AFB and in culture negative cases. DSS indicated relevance for this diagnostic approach of intrathoracic TB (ITB) in reference centers for presenting data both with high sensitivity and specificity.