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GeneXpert of stool versus gastric lavage fluid for the diagnosis of pulmonary tuberculosis in severely ill adults

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Abstract

Purpose

Stool is an alternative specimen matrix for tuberculosis (TB) tests, because Mycobacterium tuberculosis (MTB) can be swallowed and detected in the samples from digestive tract. We aimed to assess the performance of GeneXpert on stool and gastric lavage fluid (GALF) in diagnosing TB among patients with severe pulmonary TB.

Methods

We enrolled adults with suspected pulmonary TB who were unable to produce sputum at visit between January 2016 and June 2018. Bacteriological samples consisted of one transtracheal aspirate sputum specimen, one stool specimen and/or one gastric lavage fluid specimen. Bacterial culture of transtracheal aspirate sputum provided the gold standard.

Results

Of 65 individuals recruited for analysis, MGIT culture identified the presence of MTB in 32 samples. Overall, 29 of 32 stool samples from culture-positive cases were detected by the GeneXpert test, demonstrating a sensitivity of 90.6%. For GALF, 13 patients were detected as infected with MTB by GeneXpert, yielding a sensitivity of 56.5%. The statistical analysis revealed that GeneXpert showed significantly better sensitivity in detecting MTB from stool samples than GALF samples (P = 0.003). Among individuals with GeneXpert-positive stool, the percentage of individuals with comorbid diabetes was significantly higher than among individuals with GeneXpert-negative stool (19.4% vs. 2.9%, P = 0.034).

Conclusions

In conclusion, our data reveal that GeneXpert provides a higher detection rate on stool compared to GALF, indicating stool should be considered as an alternative for adult TB patients unable to produce sputum. Individuals with diabetes are more likely to have positive GeneXpert stool than nondiabetic individuals.

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References

  1. World Health Organization. Global tuberculosis report 2017. Geneva: WHO 2017; 2017 (WHO/HTM/TB/2017.13).

    Google Scholar 

  2. Tan Y, Su B, Zheng H, Wang Y, Pang Y. Prothionamide susceptibility testing of Mycobacterium tuberculosis using the resazurin microtitre assay and the BACTECMGIT 960 system. Eur J Clin Microbiol Infect Dis. 2017;36:779–82.

    Article  CAS  PubMed  Google Scholar 

  3. Nahid P, Pai M, Hopewell PC. Advances in the diagnosis and treatment of tuberculosis. Proc Am Thorac Soc. 2006;3:103–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Pai M, Schito M. Tuberculosis diagnostics in 2015: landscape, priorities, needs, and prospects. J Infect Dis. 2015;211:21-8.

    Article  Google Scholar 

  5. Aslam W, Tahseen S, Schomotzer C, Hussain A, Khanzada F, Ul Haq M, et al. Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan. Public Health Action. 2017;7:141–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Pang Y, Wang Y, Zhao S, Liu J, Zhao Y, Li H. Evaluation of the Xpert MTB/RIF assay in gastric lavage aspirates for diagnosis of smear-negative childhood pulmonary tuberculosis. Pediatr Infect Dis J. 2014;33:1047–51.

    Article  PubMed  Google Scholar 

  7. Larson JL, Ridzon R, Hannan MM. Sputum induction versus fiberoptic bronchoscopy in the diagnosis of tuberculosis. Am J Respir Crit Care Med. 2001;163:1279–80.

    Article  CAS  PubMed  Google Scholar 

  8. Ruiz Jimenez M, Guillen Martin S, Prieto Tato LM, Cacho Calvo JB, Alvarez Garcia A, Soto Sanchez B, et al. Induced sputum versus gastric lavage for the diagnosis of pulmonary tuberculosis in children. BMC Infect Dis. 2013;13:222.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wolf H, Mendez M, Gilman RH, Sheen P, Soto G, Velarde AK, et al. Diagnosis of pediatric pulmonary tuberculosis by stool PCR. Am J Trop Med Hyg. 2008;79:893–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cordova J, Shiloh R, Gilman RH, Sheen P, Martin L, Arenas F, et al. Evaluation of molecular tools for detection and drug susceptibility testing of Mycobacterium tuberculosis in stool specimens from patients with pulmonary tuberculosis. J Clin Microbiol. 2010;48:1820–6.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Walters E, van der Zalm MM, Palmer M, Bosch C, Demers AM, Draper H, et al. Xpert MTB/RIF on stool is useful for the rapid diagnosis of tuberculosis in young children with severe pulmonary disease. Pediatr Infect Dis J. 2017;36:837–43.

    Article  PubMed  PubMed Central  Google Scholar 

  12. World Health Organization. Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children, WHO Policy update. Geneva: WHO 2014; 2014. (WHO/HTM/TB/2013.16).

    Google Scholar 

  13. Orikiriza P, Nansumba M, Nyehangane D, Bastard M, Mugisha IT, Nansera D, et al. Xpert MTB/RIF diagnosis of childhood tuberculosis from sputum and stool samples in a high TB-HIV-prevalent setting. Eur J Clin Microbiol Infect Dis. 2018.

  14. Tan Y, Li Q, Wang Q, Sun H, Chen J, Cai X, et al. Evaluation of the MTBDRplus 2.0 assay for the detection of multidrug resistance among persons with presumptive pulmonary TB in China. Sci Rep. 2017;7:3364.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Rahman SMM, Maliha UT, Ahmed S, Kabir S, Khatun R, Shah JA, et al. Evaluation of Xpert MTB/RIF assay for detection of Mycobacterium tuberculosis in stool samples of adults with pulmonary tuberculosis. PLoS One. 2018;13:e0203063.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Nicol MP, Spiers K, Workman L, Isaacs W, Munro J, Black F, et al. Xpert MTB/RIF testing of stool samples for the diagnosis of pulmonary tuberculosis in children. Clin Infect Dis. 2013;57:e18–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Blakemore R, Story E, Helb D, Kop J, Banada P, Owens MR, et al. Evaluation of the analytical performance of the Xpert MTB/RIF assay. J Clin Microbiol. 2010;48:2495–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5:e152.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Podell BK, Ackart DF, Obregon-Henao A, Eck SP, Henao-Tamayo M, Richardson M, et al. Increased severity of tuberculosis in Guinea pigs with type 2 diabetes: a model of diabetes-tuberculosis comorbidity. Am J Pathol. 2014;184:1104–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ronacher K, Joosten SA, van Crevel R, Dockrell HM, Walzl G, Ottenhoff TH. Acquired immunodeficiencies and tuberculosis: focus on HIV/AIDS and diabetes mellitus. Immunol Rev. 2015;264:121–37.

    Article  CAS  PubMed  Google Scholar 

  21. Banada PP, Naidoo U, Deshpande S, Karim F, Flynn JL, O’Malley M, et al. A novel sample processing method for rapid detection of tuberculosis in the stool of pediatric patients using the Xpert MTB/RIF assay. PLoS One. 2016;11:e0151980.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank members of the National Tuberculosis Reference Laboratory at the Chinese Center for Disease Control and Prevention for their technical assistance.

Funding

This work was supported by the Beijing Municipal Administration of Hospitals’ Youth Programme (QML20171601), and the Chinese Clinical Trial Cooperation Support Programme (2018KYJJ002).

Author information

Author notes

  1. Rongmei Liu, Qian Liang and Yuanyuan Shang are co-first authors and contributed equally to this study.

Authors and Affiliations

  1. Tuberculosis Department, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, No 97, Machang, Tongzhou District, Beijing, 101149, People’s Republic of China

    Rongmei Liu & Mengqiu Gao

  2. Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, No. 97, Machang, Tongzhou District, Beijing, 101149, China

    Qian Liang, Yuanyuan Shang, Yifeng Ma, Fen Wang, Lingling Dong, Hairong Huang & Yu Pang

Authors
  1. Rongmei Liu
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  2. Qian Liang
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  3. Yuanyuan Shang
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  4. Yifeng Ma
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  5. Fen Wang
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  6. Lingling Dong
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  7. Hairong Huang
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  8. Mengqiu Gao
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  9. Yu Pang
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Corresponding authors

Correspondence to Hairong Huang, Mengqiu Gao or Yu Pang.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the Ethic Committee of Beijing Chest Hospital affiliated to Capital Medical University. Written informed consent was obtained from the immediate relative on behalf of each patient.

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Liu, R., Liang, Q., Shang, Y. et al. GeneXpert of stool versus gastric lavage fluid for the diagnosis of pulmonary tuberculosis in severely ill adults. Infection 47, 611–616 (2019). https://doi.org/10.1007/s15010-019-01295-5

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  • DOI: https://doi.org/10.1007/s15010-019-01295-5

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