Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study.
Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania.



Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising "culture and/or cytology" was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis.



Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %.



Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children.
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. maira.bholla@gmail.com.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland. maira.bholla@gmail.com.|Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania. maira.bholla@gmail.com.
Maira
0000-0003-4831-3420
M
Bholla
National TB and Leprosy Clinic, Temeke District Hospital, P.O. Box 45232, Dar es Salaam, Tanzania.
Neema
N
Kapalata
National TB and Leprosy Clinic, Temeke District Hospital, P.O. Box 45232, Dar es Salaam, Tanzania.
Edward
E
Masika
Department of Histopathology, Muhimbili University of Health and Allied Sciences, P.O. Box 65000, Dar es Salaam, Tanzania.|The Aga Khan Hospital, P.O. Box 2289, Dar es Salaam, Tanzania.
Hassan
H
Chande
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland.|Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania.
Levan
L
Jugheli
Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania.
Mohamed
M
Sasamalo
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
Tracy R
TR
Glass
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
Hans-Peter
HP
Beck
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland.|Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania.
Klaus
K
Reither
D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008198:Lymph Nodes / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013636:Tanzania; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000382:microbiology
Childhood; Culture; Cytology; Fine needle aspiration; Lymphadenitis; Mycobacterium tuberculosis; Nucleic acid amplification; Ustar EasyNAT; Xpert MTB/RIF; Ziehl-Neelsen