News 2024

The diagnosis of pulmonary tuberculosis is classically based on the identification of the bacterial pathogen, Mycobacterium tuberculosis, from the sputum. This is done either by cultural detection or by detecting the genetic material of the bacteria using a molecular biological method known as the polymerase chain reaction, or PCR for short. If only a few bacteria are present in the sputum, PCR technology is superior to microscopic detection of acid-fast bacilli in the sputum for the diagnosis of pulmonary tuberculosis. Automated procedures allow a diagnosis to be made in less than two hours. The cultivation of bacteria, on the other hand, often takes many weeks.

Children are often unable to produce sputum. Alternatively, attempts are made to find acid-fast bacilli in aspirated gastric juice and to find mycobacteria using PCR and cultures. This method is invasive and many children find it traumatic.

As an alternative to gastric juice, the genetic material of mycobacteria can also be identified from stool, a method recommended by the World Health Organization (WHO) for the diagnosis of tuberculosis.

Stool4TB is an international consortium of physicians and scientists with the participation of the Research Center Borstel, who are evaluating stool-based methods for the diagnosis of tuberculosis with funding from the European Commission in the EDCTP program.

Part of the work of Stool4TB is the evaluation of the evidence of stool-based PCR methods for the diagnosis of pulmonary tuberculosis in children. In a systematic review of the available literature, 35 out of 4521 publications were identified and included in a meta-analysis of the scientific data. Compared to a bacteriological standard from sputum-based diagnostics, the automated method “Xpert-Ultra” had a 73% sensitivity for the diagnosis of the genetic material of tuberculosis bacteria from stool as a marker for pulmonary tuberculosis. Stool-based PCR diagnostics increased the hit rate for the diagnosis of pulmonary tuberculosis in children under the age of 16 by 38%. Results were published in the journal The Lancet Microbe.

“Stool-based PCR is the new standard for the diagnosis of pulmonary tuberculosis in children,” explains Professor Christoph Lange, Medical Director of the Research Center Borstel, Leibniz Lung Center, one of the members of stool4TB and co-author of the publication.

Reference:

Carratalà Castro L, Munguambe S, Saavedra-Cervera B, de Haas P, Kay A, Marcy O, Nabeta P, Ssengooba W, Ghimenton-Walters E, Acácio S, Bonnet M, Ehrlich J, DiNardo AR, Vasiliu A, Lange C, Hermans S, Mandalakas AM, López-Varela E, García-Basteiro AL, on behalf of the Stool4TB Global Partnership. Use of stool-based molecular tests for pediatric tuberculosis diagnosis: a systematic review and meta-analysis. Lancet Microbe 2024 Published Online https://doi.org/10.1016/j.lanmic.2024.100963

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