A Prospective Evaluation of Xpert MTB/RIF Ultra for Childhood Pulmonary Tuberculosis in Uganda

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Date
2021Author
Jaganath, Devan
Wambi, Peter
Reza, Tania F.
Nakafeero, Jascent
Aben, Ernest O.
Kiconco, Emma
Nannyonga, Gertrude
Nsereko, Moses
Sekadde, Moorine P.
Mudiope, Mary
Kato-Maeda, Midori
Starke, Jeffrey
Andama, Alfred
Mohanty, Swomitra
Wobudeya, Eric
Cattamanchi, Adithya
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Show full item recordAbstract
Xpert MTB/RIF Ultra (Xpert Ultra) has improved the sensitivity to detect pulmonary tuberculosis (TB) in adults.
However, there have been limited prospective evaluations of its diagnostic accuracy in children.
Methods. We enrolled children undergoing assessment for pulmonary TB in Kampala, Uganda, over a 12-month period.
Children received a complete TB evaluation and were classified as Confirmed, Unconfirmed, or Unlikely TB. We calculated the sensitivity
and specificity of Xpert Ultra among children with Confirmed vs Unlikely TB. We also determined the diagnostic accuracy
with clinical, microbiological, and extended microbiological reference standards (MRSs).
Results. Of the 213 children included, 23 (10.8%) had Confirmed TB, 88 (41.3%) had Unconfirmed TB, and 102 (47.9%) had
Unlikely TB. The median age was 3.9 years, 13% were HIV-positive, and 61.5% were underweight. Xpert Ultra sensitivity was 69.6%
(95% confidence interval [CI]: 47.1-86.8) among children with Confirmed TB and decreased to 23.4% (95% CI: 15.9-32.4) with
the clinical reference standard. Specificity was 100% (95% CI: 96.4-100) among children with Unlikely TB and decreased to 94.7%
(95% CI: 90.5-97.4) with a MRS. Sensitivity was 52.9% (95% CI: 35.1-70.2) and specificity 95.5% (95% CI: 91.4-98.1) with the extended
MRS. Of the 26 positive Xpert Ultra results, 6 (23.1%) were “Trace-positive,” with most (5/6) occurring in children with
Unconfirmed TB.
Conclusions. Xpert Ultra is a useful tool for diagnosing pulmonary TB in children, but there remains a need for more sensitive
tests to detect culture-negative TB.
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- Medical and Health Sciences [3670]