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Volume 31, Number 3—March 2025
Online Report

Lessons Learned from Early Implementation and Scale-up of Stool-Based Xpert Testing to Diagnose Tuberculosis in Children

Eveline Klinkenberg1Comments to Author , Petra de Haas1, Charles Manyonge, Joanita Namutebi, Bibiche Mujangi, Hebert Mutunzi, Amri Kingalu, Nkiru Nwokoye, Kuzani Mbendera, Yohannes D. Babo, Gulmira Kalmambetova, Gunta Dravniece, Winnie Mwanza, Ahmed Bedru, Degu D. Jerene, Lisa V. Adams, Andwele Mwansasu, and Charlotte Colvin
Author affiliation: ConnectTB, the Hague, the Netherlands (E. Klinkenberg); Amsterdam University Medical Centers, Amsterdam, the Netherlands (E. Klinkenberg); KNCV Tuberculosis Foundation, the Hague (P. de Haas, D. D. Jerene); Supra National Reference Laboratory, Kampala, Uganda (C. Manyonge, J. Namutebi); National Reference Laboratory and National TB Program, Kinshasa, Democratic Republic of Congo (B. Mujangi); USAID, Infectious Disease Detection and Surveillance Project, Harare, Zimbabwe (H. Mutunzi); Central Tuberculosis Reference Laboratory, Dar es Salaam, Tanzania (A. Kingalu); KNCV Nigeria, Abuja, Nigeria (N. Nwokoye); National Tuberculosis Program, Lilongwe, Malawi (K. Mbendera); KNCV Tuberculosis Foundation, Addis Ababa, Ethiopia (Y.D. Babo, A. Bedru); Ministry of Health, Bishek, Kyrgyzstan (G. Kalmambetova); PATH, Kiev, Ukraine (G. Dravniece); Ministry of Health, Lusaka, Zambia (W. Mwanza); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA (L.V. Adams); USAID Infectious Disease Detection and Surveillance Project, Washington, DC, USA (A. Mwansasu); USAID Bureau for Global Health, Washington (C. Colvin); Credence Management Solutions, LLC, McLean, Virginia, USA (C. Colvin)

Main Article

Table 4

Patient narratives from Kyrgyzstan, Ethiopia, and Tanzania shared during the TB Union World Lung Health Conference Workshop, 2023*

Country
 Narrative
Kyrgystan
 A 2 year-old boy, from Bishkek city. TB contact: The child’s mother received a diagnosis of “infiltrative MDR-TB” in May 2022. According to his mother, the child did not have any symptoms at that time. On May 30, the child was evaluated as a close contact. His radiograph showed a primary tuberculosis complex. A throat swab sample was smear and Xpert negative. The clinician wanted to start TB treatment; however, the child's father refused. In October 2022, the following sign/symptoms developed in the child: lethargy, low-grade fever, poor appetite. On October 26, stool was collected at the regional TB center, the first site to commence stool testing in Kyrgyzstan. The Xpert results showed detection of trace MTBC. In November 2022, the child’s chest radiograph showed hilar adenopathy. Drug-resistant TB treatment using an individualized regimen was initiated. The child is still receiving treatment as an outpatient and is responding well.
Ethiopia
 A 5-month-old infant, from Moyale town. The infant was examined for severe acute malnutrition. She also had persistent respiratory symptoms and was noted to have no TB contact history. She had frequently visited a hospital and was screened for TB at the nutrition clinic and found to have TB suggestive symptoms (persistent cough and weight loss). Stool was tested and the result was low detection of MTBC. In the absence of a TB contact history, the clinician was uncertain about a TB diagnosis and opted to perform gastric aspiration. The gastric aspirate result was positive for MTBC, high. Because the infant was examined at the first site in the country to implement stool-based testing, confidence in stool-based testing was still low. Drug-susceptible TB treatment was initiated, and 4 months into treatment, the infant was doing well.
Tanzania A 13-year-old girl, living with HIV, from Morogoro Municipality. The child initially was given a diagnosis of TB based on her chest radiograph (showing bilateral homogenous opacity on mid zones), and first-line TB treatment was completed in 9 months (June 2022–March 2023). Treatment was extended from the standard 6-month regimen as a result of 2 episodes of treatment interruption of 5 and 6 weeks. Five months later, in August 2023, her condition changed, and she was admitted to the pediatric intensive care unit, requiring oxygen therapy. She failed to produce a sputum sample, and a stool sample was collected and tested positive for MTBC and rifampicin resistance. Treatment for drug-resistant TB was commenced, and after 10 days in intensive care, she was transferred to the ward and discharged the following day. She fully recovered and took and passed her final primary school examination and commenced secondary school.

MDR, multidrug resistant; MTBC, Mycobacterium tuberculosis complex; TB, tuberculosis; Xpert, Xpert MTB/RIF or Xpert MTB/RIF Ultra (Cefeid, https://www.cepheid.com).

Main Article

1These first authors contributed equally to this article.

Page created: February 07, 2025
Page updated: February 28, 2025
Page reviewed: February 28, 2025
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