Prospective study to find out the role of gastric aspirate examination by Ziehl-Neelsen staining (ZN staining) and cartridge based nucleic acid amplification test (CB-NAAT) as a diagnostic method in childhood tuberculosis

Background: Tuberculosis in children has been relatively neglected mainly because clinical diagnosis has low specificity, radiological interpretation is subject to inter-observer variability and the tuberculin skin test is a marker of exposure, not disease. The recent introduction of Cartridge based nucleic acid amplification test has significantly transformed the diagnostics of tuberculosis in adults but its application for Paediatric Tuberculosis is under evaluation. Therefore, authors conducted a study on role of gastric aspirate examination by ZN stain and Cartridge based nucleic acid amplification test in the diagnosis of childhood Tuberculosis.Methods: Authors did a prospective hospital-based study from Nov 2016 to Nov 2017 consisting of 100 randomly selected patients suspected of tuberculosis who had their gastric aspirate tested for CBNAAT and ZN stain for acid fast bacilli (AFB) along with Mantoux test and other routine investigations. Chi square test was used.Results: Culture positive tuberculosis was found in 21 out of 100 children. The sensitivity, specificity, positive predictive value and negative predictive value for CBNAAT were 76.1%, 98.7%, 94.1% and 93.9% and for ZN stain were 47.6%, 98.7%, 90.9% and 87.6% respectively. Positive history of contact (p value 0.0217), reactive Mantoux test (p value < 0.001) and low socioeconomic status were independently associated with a positive CBNAAT result.Conclusions: Analysis of gastric aspirate samples with CBNAAT is a sensitive and specific method for rapid diagnosis of pulmonary tuberculosis in children who cannot produce sputum. Compared with microscopy, CBNAAT offers better sensitivity and its scale up will improve access to tuberculosis diagnostics in children.

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Cartridge Based Nucleic Acid Amplification Test: Utility as Diagnostic Modality in Clinically Diagnosed Childhood Tuberculosis

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44496.13885 ◽

2020 ◽

Author(s):

Rajesh Kumar Yadav ◽

Durgesh Kumar ◽

Yogendra Singh Yadav ◽

Dinesh Kumar Singh ◽

Amit Singh ◽

...

Keyword(s):

Nucleic Acid ◽

Diagnostic Test ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Mantoux Test ◽

P Value ◽

Suspected Case ◽

Gastric Aspirate ◽

Csf Analysis ◽

Conventional Methods

Introduction: Tuberculosis (TB) remains one of the deadliest communicable diseases worldwide. The introduction of early and rapid diagnostic test such as Cartridge Based Nucleic Acid Amplification Test (CBNAAT) creates opportunities for improvement in early and fast detection of TB and drug-resistance. Aim: To determine the prevalence of Tubercular cases in clinically diagnosed TB patients and to determine the prevalence of Rifampicin resistance by CBNAAT. Materials and Methods: This prospective observational study involved a total of 107 children from January 2018 to June 2019, fulfilling the inclusion criteria who were clinically diagnosed and found positive in conventional tests for TB. CBNAAT was used to confirm Mycobacterium tuberculosis (MTB) for the diagnosis of childhood TB and compare with other conventional methods. Chi-square test for the proportion was applied and p-value <0.05 taken as significant. Results: Of the 107 patients studied, 44.9% were female and 55.1% were male. The age range was 3 months to 12 years. The cases were confirmed by CBNAAT in clinically suspected case of TB was found to be 17.8% (19 cases out of 107 patients). CBNAAT was able to detect MTB in 14% (15 cases out of 107 patients) of the gastric aspirate/sputum sample. Out of 107 patients, 69 children were clinically diagnosed as Neurotuberculosis and 13% (9 out of 69 cases) cases were confirmed by CBNAAT in Cerebrospinal Fluid (CSF). OF which 29 patients had CSF analysis suggestive of Tubercular Meningitis (TBM). Out of 29 patients, 10 (34.5%) cases were confirmed by CBNAAT. This test showed a significant association with positive Mantoux test (p-value 0.020) and CSF analysis (p-value 0.021) suggestive of TBM. Conclusion: CBNAAT should be used in preference to conventional methods as the initial diagnostic test for patients suspected of having TB. CBNAAT positivity shows significant association with positive Mantoux test and CSF analysis suggestive of TBM.

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EVALUATION OF CARTRIDGE-BASED NUCLEIC ACID AMPLIFICATION TEST FOR DIAGNOSIS OF TUBERCULOSIS IN CHILDREN IN VARIOUS BODY FLUIDS

Indian Journal of Child Health ◽

10.32677/ijch.2019.v06.i07.005 ◽

2019 ◽

Vol 6 (7) ◽

pp. 349-352

Author(s):

Dipti Agarwal ◽

Rakesh Bhatia ◽

Rajeshwar Dayal ◽

Rhythm Khera ◽

Shamrendra Narayan ◽

...

Keyword(s):

Nucleic Acid ◽

Body Fluids ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Tuberculosis In Children

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Study on cartridge based nucleic acid amplification test in children with Neurotuberculosis at RNT Medical College, Udaipur, Rajasthan, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192760 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1588

Author(s):

Shashi Bala ◽

Suresh Goyal

Keyword(s):

Mycobacterium Tuberculosis ◽

Nucleic Acid ◽

Clinical Evaluation ◽

Controlled Trial ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Gastric Aspirate ◽

Age Group ◽

Major Health Problem ◽

Medical College

Background: The aim was to determine utility of Cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of mycobacterium tuberculosis in children with neurotuberculosis diagnosed on the basis of clinical evaluation, CSF findings and neuroimaging.Methods: A prospective randomized controlled trial was conducted in Pediatric Department of RNT Medical College, Udaipur, Rajasthan, India from July 2017 to June 2018. Total 110 children of age group of 6 months to 18 years with the diagnosis of tubercular meningoencephalitis (TBME) on the basis of clinical evaluation, CSF examination and neuroimaging were included in the study.Results: A total 110 children were enrolled. Maximum number of cases admitted with TBME were among 1-5 years of age group (60.91%). CSF and gastric aspirate were examined by CBNAAT for MTB. 5 (4.55%) children had CBNAAT positivity in CSF. Gastric aspirate was positive among 16 (14.55%) children. None of the patient had CBNAAT positive result both in CSF and gastric aspirate.Conclusions: TBME is a major health problem in children below 5 years. Gene Xpert assay has the potential to significantly improve and escalate the diagnosis of smear-negative body fluid specimens. CBNAAT for mycobacterium tuberculosis was positive in 5 (4.55%) children from CSF and 16 (14.55%) from gastric aspirate. Negative CBNAAT should not prevent any patient with suspected features of TBME from starting anti tubercular treatment (ATT) as sensitivity of this test remains low. Final judgement to start ATT should be based on clinical, biochemical and radiological profile especially in CNS tuberculosis.

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Low Positive Predictive Value of a Nucleic Acid Amplification Test for NongenitalNeisseria gonorrhoeaeInfection in Homosexual Men

Clinical Infectious Diseases ◽

10.1086/589299 ◽

2008 ◽

Vol 47 (2) ◽

pp. e25-e27 ◽

Cited By ~ 27

Author(s):

Leon P. McNally ◽

David J. Templeton ◽

Fengyi Jin ◽

Andrew E. Grulich ◽

Basil Donovan ◽

...

Keyword(s):

Nucleic Acid ◽

Positive Predictive Value ◽

Predictive Value ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Homosexual Men

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False‐Positive Gonorrhea Test Results with a Nucleic Acid Amplification Test: The Impact of Low Prevalence on Positive Predictive Value

Clinical Infectious Diseases ◽

10.1086/381895 ◽

2004 ◽

Vol 38 (6) ◽

pp. 814-819 ◽

Cited By ~ 34

Author(s):

Alan R. Katz ◽

Paul V. Effler ◽

Roy G. Ohye ◽

Barbara Brouillet ◽

Maria Veneranda C. Lee ◽

...

Keyword(s):

Nucleic Acid ◽

Positive Predictive Value ◽

Predictive Value ◽

False Positive ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Test Results ◽

Low Prevalence ◽

The Impact

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Changing Clinicoradiologic Spectrum of Intracranial Neurotuberculosis in Children: A Cross-sectional Study

Journal of Child Neurology ◽

10.1177/0883073820938594 ◽

2020 ◽

Vol 35 (13) ◽

pp. 879-888

Author(s):

Sumiti Banga ◽

Chandrika Azad ◽

Rekha Gupta ◽

Nishit Sawal ◽

Vidushi Mahajan ◽

...

Keyword(s):

Nucleic Acid ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Gastric Aspirate ◽

Sectional Study ◽

Tubercular Meningitis ◽

Cross Sectional

Background: Neurotuberculosis is among the most severe type of tuberculosis with high mortality and morbidity in all age groups. Various sociodemographic and disease-/treatment-related factors have emerged over the years that can affect clinical and radiologic features of neurotuberculosis. Objective: To investigate various clinical and neuroradiologic presentations of neurotuberculosis. Methodology: This cross-sectional study was done in a tertiary care center of northern India. The patients between the ages of 3 months and 18 years with newly diagnosed neurotuberculosis were enrolled after taking informed consent. Results: A total of 78 patients (37% males) were enrolled. Fifty-six patients (72%) had tubercular meningitis (TBM) and 22 (28%) isolated tuberculomas. Very high percentage of patients in both the groups was BCG vaccinated. In the tubercular meningitis group, fever (68%), headache (59%), and vomiting (54%) were the most common complaints whereas in the tuberculoma group, seizures (95.5%) were the main complaint and systemic symptoms were rare. In tubercular meningitis patients, cerebrospinal fluid–based studies showed cartridge-based nucleic acid amplification test (Xpert MTB/RIF) positivity for Mycobacterium tuberculosis in 17.6% cases, whereas on gastric aspirate and sputum examination, acid-fast bacilli were seen in 30.7% and cartridge-based nucleic acid amplification test was positive in 19% patients. On neuroimaging, hydrocephalus was seen in 44.6% of tubercular meningitis patients, infarcts in 32%, and basal exudates in 12% patients only; coexistent tuberculomas were seen in 53%. Conclusion: Compared with the available literature, the present study showed a smaller percentage of children <5 years of age, stage III tubercular meningitis cases, and typical neuroradiologic findings like hydrocephalus and basal exudates and more tuberculomas associated with tubercular meningitis.

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