Original Research

Xpert MTB/RIF Ultra and mycobacterial culture in routine clinical care at a paediatric hospital

Anthony K. Enimil, James J.C. Nuttall, Chad M. Centner, Natalie Beylis, Brian S. Eley
Southern African Journal of Infectious Diseases | Vol 37, No 1 | a398 | DOI: https://doi.org/10.4102/sajid.v37i1.398 | © 2022 Anthony K. Enimil, James J.C. Nuttall, Chad M. Centner, Natalie Beylis, Brian S. Eley | This work is licensed under CC Attribution 4.0
Submitted: 27 December 2021 | Published: 20 June 2022

About the author(s)

Anthony K. Enimil, Department of Child Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
James J.C. Nuttall, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; and, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Chad M. Centner, Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
Natalie Beylis, Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Brian S. Eley, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; and, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa


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Abstract

Background: Microbiological confirmation of pulmonary tuberculosis (PTB) in children is a well-documented challenge. This study evaluated Xpert Mycobacterium Tuberculosis (MTB)/Rifampicin (RIF) Ultra (Ultra) and mycobacterial cultures in routine clinical care at a tertiary paediatric hospital.

Methods: Children treated for PTB and who had at least one respiratory specimen investigated by Ultra and mycobacterial culture before tuberculosis (TB) treatment was commenced were included. The findings of this retrospective study were summarised using descriptive and inferential statistics.

Results: A total of 174 children were included. The median age was 2.5 years. Microcytic anaemia, airway compression, cavitary disease and miliary TB were significantly observed in children with microbiologically confirmed TB (cTB). Tuberculosis was microbiologically confirmed in 93 (53.4%) children. The positive yield from testing the first respiratory specimens was 68/174 (39.1%) on Ultra and 82/174 (47.1%) on combined Ultra and mycobacterial culture. In the subset of children (n = 70) tested with Ultra on two sequential respiratory specimens, the incremental yield from the second specimen was 30.3%. In the subset of children (n = 16) tested with Ultra on three sequential respiratory specimens, the incremental yield from the second and third specimens was 16.7% and 0.0%, respectively. When Ultra and mycobacterial culture results were combined, the incremental yield in children who had two sequential respiratory specimens tested was 24.4% and 3.1% on Ultra and mycobacterial culture, respectively.

Conclusion: Ultra and mycobacterial culture on a single respiratory specimen resulted in a high microbiological yield. Ultra-testing on a second respiratory specimen increased the yield of microbiologically cTB. Additional diagnostic testing may require further study.


Keywords

diagnosing childhood tuberculosis; respiratory specimen; Xpert MTB/RIF Ultra; mycobacterial culture; incremental yield; microcytic anaemia

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