Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB.
<h4>Background</h4>Diagnosis of pulmonary tuberculosis (PTB) in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB) cases are diagnosed based onl...
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Public Library of Science (PLoS)
2014-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0105346 |
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| author | Neeraj Raizada Kuldeep Singh Sachdeva Sreenivas Achuthan Nair Shubhangi Kulsange Radhey Shayam Gupta Rahul Thakur Malik Parmar Christen Gray Ranjani Ramachandran Bhavin Vadera Shobha Ekka Shikha Dhawan Ameet Babre Mayank Ghedia Umesh Alavadi Puneet Dewan Mini Khetrapal Ashwini Khanna Catharina Boehme Chinnambedu Nainarappan Paramsivan |
| author_facet | Neeraj Raizada Kuldeep Singh Sachdeva Sreenivas Achuthan Nair Shubhangi Kulsange Radhey Shayam Gupta Rahul Thakur Malik Parmar Christen Gray Ranjani Ramachandran Bhavin Vadera Shobha Ekka Shikha Dhawan Ameet Babre Mayank Ghedia Umesh Alavadi Puneet Dewan Mini Khetrapal Ashwini Khanna Catharina Boehme Chinnambedu Nainarappan Paramsivan |
| author_sort | Neeraj Raizada |
| collection | DOAJ |
| description | <h4>Background</h4>Diagnosis of pulmonary tuberculosis (PTB) in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB) cases are diagnosed based only on clinical findings. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents the results from pediatric groups taking part in a large demonstration study wherein Xpert MTB/RIF testing replaced smear microscopy for all presumptive PTB cases in public health facilities across India.<h4>Methods</h4>The study covered a population of 8.8 million across 18 programmatic sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each study TU. Pediatric presumptive PTB cases (both TB and Drug Resistant TB (DR-TB)) accessing any public health facilities in study area were prospectively enrolled and tested on Xpert MTB/RIF following a standardized diagnostic algorithm.<h4>Results</h4>4,600 pediatric presumptive pulmonary TB cases were enrolled. 590 (12.8%, CI 11.8-13.8) pediatric PTB were diagnosed. Overall 10.4% (CI 9.5-11.2) of presumptive PTB cases had positive results by Xpert MTB/RIF, compared with 4.8% (CI 4.2-5.4) who had smear-positive results. Upfront Xpert MTB/RIF testing of presumptive PTB and presumptive DR-TB cases resulted in diagnosis of 79 and 12 rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high (98%, CI 90.1-99.9), with no statistically significant variation with respect to past history of treatment.<h4>Conclusion</h4>Upfront access to Xpert MTB/RIF testing in pediatric presumptive PTB cases was associated with a two-fold increase in bacteriologically-confirmed PTB, and increased detection of rifampicin-resistant TB cases under routine operational conditions across India. These results suggest that routine Xpert MTB/RIF testing is a promising solution to present-day challenges in the diagnosis of PTB in pediatric patients. |
| format | Article |
| id | doaj-art-763946fbf68b40049a8255ed7b982ae3 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-763946fbf68b40049a8255ed7b982ae32025-08-20T03:10:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0198e10534610.1371/journal.pone.0105346Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB.Neeraj RaizadaKuldeep Singh SachdevaSreenivas Achuthan NairShubhangi KulsangeRadhey Shayam GuptaRahul ThakurMalik ParmarChristen GrayRanjani RamachandranBhavin VaderaShobha EkkaShikha DhawanAmeet BabreMayank GhediaUmesh AlavadiPuneet DewanMini KhetrapalAshwini KhannaCatharina BoehmeChinnambedu Nainarappan Paramsivan<h4>Background</h4>Diagnosis of pulmonary tuberculosis (PTB) in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB) cases are diagnosed based only on clinical findings. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents the results from pediatric groups taking part in a large demonstration study wherein Xpert MTB/RIF testing replaced smear microscopy for all presumptive PTB cases in public health facilities across India.<h4>Methods</h4>The study covered a population of 8.8 million across 18 programmatic sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each study TU. Pediatric presumptive PTB cases (both TB and Drug Resistant TB (DR-TB)) accessing any public health facilities in study area were prospectively enrolled and tested on Xpert MTB/RIF following a standardized diagnostic algorithm.<h4>Results</h4>4,600 pediatric presumptive pulmonary TB cases were enrolled. 590 (12.8%, CI 11.8-13.8) pediatric PTB were diagnosed. Overall 10.4% (CI 9.5-11.2) of presumptive PTB cases had positive results by Xpert MTB/RIF, compared with 4.8% (CI 4.2-5.4) who had smear-positive results. Upfront Xpert MTB/RIF testing of presumptive PTB and presumptive DR-TB cases resulted in diagnosis of 79 and 12 rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high (98%, CI 90.1-99.9), with no statistically significant variation with respect to past history of treatment.<h4>Conclusion</h4>Upfront access to Xpert MTB/RIF testing in pediatric presumptive PTB cases was associated with a two-fold increase in bacteriologically-confirmed PTB, and increased detection of rifampicin-resistant TB cases under routine operational conditions across India. These results suggest that routine Xpert MTB/RIF testing is a promising solution to present-day challenges in the diagnosis of PTB in pediatric patients.https://doi.org/10.1371/journal.pone.0105346 |
| spellingShingle | Neeraj Raizada Kuldeep Singh Sachdeva Sreenivas Achuthan Nair Shubhangi Kulsange Radhey Shayam Gupta Rahul Thakur Malik Parmar Christen Gray Ranjani Ramachandran Bhavin Vadera Shobha Ekka Shikha Dhawan Ameet Babre Mayank Ghedia Umesh Alavadi Puneet Dewan Mini Khetrapal Ashwini Khanna Catharina Boehme Chinnambedu Nainarappan Paramsivan Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB. PLoS ONE |
| title | Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB. |
| title_full | Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB. |
| title_fullStr | Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB. |
| title_full_unstemmed | Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB. |
| title_short | Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB. |
| title_sort | enhancing tb case detection experience in offering upfront xpert mtb rif testing to pediatric presumptive tb and dr tb cases for early rapid diagnosis of drug sensitive and drug resistant tb |
| url | https://doi.org/10.1371/journal.pone.0105346 |
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