Piloting Upfront Xpert MTB-RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB and DR-TB in Paediatric PopulationReportar como inadecuado




Piloting Upfront Xpert MTB-RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB and DR-TB in Paediatric Population - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB-RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO.

Method

Xpert MTB-RIF testing was offered to all paediatric 0–14 years presumptive TB cases both pulmonary and extra-pulmonary seeking care at public and private health facilities in the project areas covering 4 cities of India.

Results

Under this pilot project, 8,370 paediatric presumptive TB and presumptive DR-TB cases were tested between April and–November 2014. Overall, 9,149 specimens were tested, of which 4,445 48.6% were non-sputum specimens. Xpert MTB-RIF gave 9,083 99.2%, CI 99.0–99.4 valid results. Of the 8,143 presumptive TB cases enrolled, 517 6.3%, CI 5.8–6.9 were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB-RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project.

Conclusion

Xpert MTB-RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance.



Autor: Neeraj Raizada , Kuldeep Singh Sachdeva, Soumya Swaminathan, Shubhangi Kulsange, Sunil D. Khaparde, Sreenivas Achuthan Nair, Ashw

Fuente: http://plos.srce.hr/



DESCARGAR PDF




Documentos relacionados