Uso do Gene-Xpert ultra no diagnóstico da tuberculose pulmonar em crianças e adolescentes

Abstract

Objective: To evaluate Ultra’s contribution in the diagnosis of pediatric pulmonary tuberculosis (PTB). Methods: We analyzed prospective data from children and adolescents with presumed PTB, whose specimens were submitted to Ultra between January 2020 and December 2022. The diagnosis was based on clinical-radiological criteria, clinical response after a 2-month treatment and microbiological analysis. Ultra was considered positive with a result of Detected and Traces in children under 10 years and in HIV-infected individuals. Fisher's exact test was used for group comparisons and McNemar's test was used to compare Ultra results with the diagnostic presumption. The study was approved by the Ethics Committee (CAAE no 02173518.2.0000.5264). Results: We included 41 patients, of whom 63% (26/41) were diagnosed with PTB. From these, 9/26 (34%) had positive results only thru Ultra, with negative AFB and culture. The sensitivity and specificity of Ultra were 50% (13/26) and 100% (15/15), respectively. The PPV was 100% (13/13) and the NPV was 54% (15/28). From these 28 (68%) with negative Ultra results, 13 (46%) were diagnosed with PTB, mostly by MoH-SS. Considering culture as the reference, the PPV and NPV were 67% and 100%, respectively. Conclusion: Ultra significantly contributed to the diagnosis of pediatric PTB, proving to be a promising tool in paucibacillary forms of the disease. However, it should not be used alone. It is essential to integrate laboratory tests with clinical evaluation, to improve diagnostic accuracy and the management of pediatric TB.