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- Title
Evidence for Tuberculosis in Individuals With Xpert Ultra "Trace" Sputum During Screening of High-Burden Communities.
- Authors
Sung, Joowhan; Nantale, Mariam; Nalutaaya, Annet; Biché, Patrick; Mukiibi, James; Kamoga, Caleb E; Akampurira, Joab; Kayondo, Francis; Kiyonga, Rogers; Mukiibi, Michael; Nakasolya, Olga; McGeehan, Molly; Dowdy, David W; Katamba, Achilles; Kendall, Emily A
- Abstract
Background "Trace" results on Xpert MTB/RIF Ultra ("Ultra"; Cepheid) —a molecular diagnostic test for tuberculosis (TB)—are often interpreted as an indication for TB treatment, but may also represent detection of nonviable bacilli or analytical error. In community-screening settings where individual TB risk is low, there is limited guidance on how to interpret Ultra-trace results. Methods We conducted systematic Ultra TB screening of adults and adolescents (≥15 years) in Kampala, Uganda, through door-to-door and event-based sputum collection. We enrolled individuals with trace-positive sputum for detailed clinical, radiographic, and microbiological (including 2 sputum cultures, repeat Ultra, and for people with HIV, urine lipoarabinomannan) evaluation, and compared those findings with similar evaluations in controls with Ultra-negative and Ultra-positive (non-trace) sputum. Results Of 21 957 people screened with Ultra, 211 (1.0%) tested positive, including 96 (46% of positives) with trace results. Of 92 people enrolled with trace-positive sputum; 12% (11/92) were HIV-positive and 14% (13/92) had prior TB. The prevalence of TB among participants with trace-positive sputum results was 14% (13/92) by culture, 24% (22/92) using broader microbiological criteria, and 26% (24/92) after accounting for clinical diagnosis. The prevalence of cough and of abnormal chest computed tomography (CT) findings were 32% and 26%, respectively, if Ultra-negative; 34% and 54% if trace-positive/non–microbiologically confirmed; 72% and 95% if trace-positive/microbiologically confirmed; and 71% and 93% if Ultra-positive (more than trace). Conclusions Most individuals with trace-positive sputum in Ugandan communities did not have microbiologically confirmed TB but had more symptoms and chest CT abnormalities than people with Ultra-negative sputum.
- Subjects
UGANDA; TUBERCULOSIS diagnosis; TUBERCULOSIS microbiology; PREDICTIVE tests; MICROBIAL sensitivity tests; RESEARCH funding; COMPUTED tomography; SPUTUM; DESCRIPTIVE statistics; HIV infections; CHEST X rays; MEDICAL screening; COUGH; MOLECULAR diagnosis; TUBERCULOSIS; SENSITIVITY &; specificity (Statistics); SYMPTOMS
- Publication
Clinical Infectious Diseases, 2024, Vol 78, Issue 3, p723
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad595