Stool culture for diagnosis of pulmonary tuberculosis in children

dc.contributor.authorWalters, Elisabettaen_ZA
dc.contributor.authorDemers, Anne-Marieen_ZA
dc.contributor.authorVan der Zalm, Marieke M.en_ZA
dc.contributor.authorWhitelaw, Andrewen_ZA
dc.contributor.authorPalmer, Meganen_ZA
dc.contributor.authorBosch, Corneen_ZA
dc.contributor.authorDraper, Heather R.en_ZA
dc.contributor.authorGie, Robert P.en_ZA
dc.contributor.authorHesseling, Anneke C.en_ZA
dc.identifier.citationWalters, E. et al. 2017. Stool culture for diagnosis of pulmonary tuberculosis in children. Journal of Clinical Microbiology, 55(12)::3355–3365, doi:10.1128/JCM.00801-17.
dc.identifier.issn1098-660X (online)
dc.identifier.issn0095-1137 (print)
dc.descriptionCITATION: Walters, E. et al. 2017. Stool culture for diagnosis of pulmonary tuberculosis in children. Journal of Clinical Microbiology, 55(12)::3355–3365, doi:10.1128/JCM.00801-17.
dc.descriptionThe original publication is available at
dc.description.abstractBacteriological confirmation of Mycobacterium tuberculosis is achieved in the minority of young children with tuberculosis (TB), since specimen collection is resource intensive and respiratory secretions are mostly paucibacillary, leading to limited sensitivity of available diagnostic tests. Although molecular tests are increasingly available globally, mycobacterial culture remains the gold standard for diagnosis and determination of drug susceptibility and is more sensitive than molecular methods for paucibacillary TB. We evaluated stool culture as an alternative to respiratory specimens for the diagnosis of suspected intrathoracic TB in a subgroup of 188 children (median age, 14.4 months; 15.4% HIV infected) enrolled in a TB diagnostic study at two local hospitals in Cape Town, South Africa. One stool culture was compared to overall bacteriological confirmation by stool Xpert and by Xpert and culture of multiple respiratory specimens. After decontamination/digestion with NALC (N-acetyl-l-cysteine)-NaOH (1.25%), concentrated fluorescent smear microscopy, Xpert MTB/RIF, and liquid culture were completed for all specimens. Culture contamination of stool specimens was high at 41.5%. Seven of 90 (7.8%) children initiating TB treatment were stool culture positive for M. tuberculosis. Excluding contaminated cultures, the sensitivity of stool culture versus confirmed TB was 6/25 (24.0%; 95% confidence interval [CI] = 9.4 to 45.1%). In addition, stool culture detected TB in 1/93 (1.1%) children with “unconfirmed TB.” Testing the same stool by Xpert increased sensitivity to 33.3% (95% CI = 18.0 to 51.8%). In conclusion, stool culture had low sensitivity for M. tuberculosis detection in children with intrathoracic TB. Reducing culture contamination through improved laboratory protocols may enable more reliable estimates of its diagnostic utility.en_ZA
dc.description.sponsorshipMedical Research Council of South Africa
dc.description.sponsorshipSouth African National Research Foundation
dc.format.extent11 pages
dc.publisherAmerican Society for Microbiology
dc.subjectTuberculosis in childrenen_ZA
dc.subjectTuberculosis in children -- Diagnosisen_ZA
dc.titleStool culture for diagnosis of pulmonary tuberculosis in childrenen_ZA
dc.description.versionPublisher's version
dc.rights.holderAuthors retain copyright

Files in this item


This item appears in the following Collection(s)