Performance of Xpert Ultra nasopharyngeal swab for identification of tuberculosis deaths in northern Tanzania.

Autor:	Costales C; Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania., Crump JA; Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand., Mremi AR; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Amsi PT; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Kalengo NH; Kilimanjaro Christian Medical Centre, Moshi, Tanzania., Kilonzo KG; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Kinabo G; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Lwezaula BF; Mawenzi Regional Referral Hospital, Moshi, Tanzania., Lyamuya F; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Marandu A; Mawenzi Regional Referral Hospital, Moshi, Tanzania., Mbwasi R; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Mmbaga BT; Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania., Mosha C; Mawenzi Regional Referral Hospital, Moshi, Tanzania., Carugati M; Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA., Madut DB; Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA., Nelson AM; Inpala Consulting, Washington, DC, USA., Maze MJ; Centre for International Health, University of Otago, Dunedin, New Zealand., Matkovic E; Infectious Disease Pathology Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Zaki SR; Infectious Disease Pathology Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Maro VP; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Rubach MP; Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore. Electronic address: matthew.rubach@duke.edu.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2022 Aug; Vol. 28 (8), pp. 1150.e1-1150.e6. Date of Electronic Publication: 2022 Mar 28.
DOI:	10.1016/j.cmi.2022.03.027
Abstrakt:	Objective: Numerous tuberculosis (TB) deaths remain undetected in low-resource endemic settings. With autopsy-confirmed tuberculosis as our standard, we assessed the diagnostic performance of Xpert MTB/RIF Ultra (Ultra; Cepheid) on nasopharyngeal specimens collected postmortem. Methods: From October 2016 through May 2019, we enrolled pediatric and adult medical deaths to a prospective autopsy study at two referral hospitals in northern Tanzania with next-of-kin authorization. We swabbed the posterior nasopharynx prior to autopsy and tested the samples later by Ultra. At autopsy we collected lung, liver, and, when possible, cerebrospinal fluid for mycobacterial culture and histopathology. Confirmed tuberculosis was defined as Mycobacterium tuberculosis complex recovery by culture with consistent tissue histopathology findings; decedents with only histopathology findings, including acid-fast staining or immunohistochemistry, were defined as probable tuberculosis. Results: Of 205 decedents, 78 (38.0%) were female and median (range) age was 45 (0,96) years. Twenty-seven (13.2%) were found to have tuberculosis at autopsy, 22 (81.5%) confirmed and 5 (18.5%) probable. Ultra detected M. tuberculosis complex from the nasopharynx in 21 (77.8%) of 27 TB cases (sensitivity 70.4% [95% confidence interval {CI} 49.8-86.2%], specificity 98.9% [95% CI 96.0-99.9%]). Among confirmed TB, the sensitivity increased to 81.8% (95% CI 59.7-94.8%). Tuberculosis was not included as a death certificate diagnosis in 14 (66.7%) of the 21 MTBc detections by Ultra. Discussion: Nasopharyngeal Ultra was highly specific for identifying in-hospital tuberculosis deaths, including unsuspected tuberculosis deaths. This approach may improve tuberculosis death enumeration in high-burden countries. (Copyright © 2022. Published by Elsevier Ltd.)
Databáze:	MEDLINE
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