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The Benefit of Mycobacterial Examination with Stool Specimens to Diagnose Tuberculosis for Adult Patients
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A5545 - The Benefit of Mycobacterial Examination with Stool Specimens to Diagnose Tuberculosis for Adult Patients
Author Block: A. Konno1, O. Narumoto1, M. Kawashima1, A. Yamane1, H. Nagai1, H. Matsui1, K. Ohta2; 1Tokyo National Hospital, Kiyose, Japan, 2Tokyo National Hospital, Tokyo, Japan.
Introduction: Tuberculosis (TB) is a life-threating disease caused by Mycobacterium tuberculosis (MT). Microscopic examination of sputum smear is often the first test to be used in suspicion of tuberculosis. In patients who have difficulty coughing up sputum, alternative respiratory tract specimens can be acquired only by invasive procedures, including aspiration of gastric juice or airway secretions, which is not always available in the feeble elderly. Several studies reported the benefit of stool test for TB children or patients with HIV infection, but few studies in adult patients. We evaluated the benefit of mycobacterial examination of stool (smear, culture, and nucleic acid amplification test) as non-invasive alternative test to detect MT infection. Methods: From September 2013 to August 2017, 2063 patients were admitted to the Tokyo National Hospital with the diagnosis or in suspicion of TB. Stool specimens were examined for mycobacteria in 300 cases. Among them, 187 cases were microbiologically diagnosed with pulmonary tuberculosis and were retrospectively reviewed. We compared the positive isolation rate of MT organisms between sputum and stool specimens collected from the same patients. MT was isolated with Mycobacteria Growth Indicator Tube (MGIT) cultures or identified with microscopic examination of smears and Transcription Reverse-transcription Concerted reaction (TRC). Patient factors related to the MT detection in stool were also investigated. Results: Among 187 TB patients included, 60.4% (113/187) were male at the median age of 74 years (54 to 85), 7 were HIV positive, 44 had miliary tuberculosis, and 7 had intestinal tuberculosis. Positive rate of MT in stool was 12.8% (24/187) by stool Acid-fast bacilli (AFB) smear, 68.1% (98/144, 43 missing data) by TRC, and 40.6% (76/187) by culture. Multivariate logistic regression analysis revealed two independently related patient factors to MT detection in stool; presence of cavity and large area affected on chest X-ray. The adjusted odds ratio (OR) with 95% confidence interval (CI) for presence of cavity was 3.66 (95%CI 1.50-8.66), and for large affected area 4.39 (95%CI 1.22-15.7). Conclusion: MT positive rate of stool specimens is fairly high. We recommend stool examination for those who are unable to give sputum and have risks for invasive procedures.
Author Block: A. Konno1, O. Narumoto1, M. Kawashima1, A. Yamane1, H. Nagai1, H. Matsui1, K. Ohta2; 1Tokyo National Hospital, Kiyose, Japan, 2Tokyo National Hospital, Tokyo, Japan.
Introduction: Tuberculosis (TB) is a life-threating disease caused by Mycobacterium tuberculosis (MT). Microscopic examination of sputum smear is often the first test to be used in suspicion of tuberculosis. In patients who have difficulty coughing up sputum, alternative respiratory tract specimens can be acquired only by invasive procedures, including aspiration of gastric juice or airway secretions, which is not always available in the feeble elderly. Several studies reported the benefit of stool test for TB children or patients with HIV infection, but few studies in adult patients. We evaluated the benefit of mycobacterial examination of stool (smear, culture, and nucleic acid amplification test) as non-invasive alternative test to detect MT infection. Methods: From September 2013 to August 2017, 2063 patients were admitted to the Tokyo National Hospital with the diagnosis or in suspicion of TB. Stool specimens were examined for mycobacteria in 300 cases. Among them, 187 cases were microbiologically diagnosed with pulmonary tuberculosis and were retrospectively reviewed. We compared the positive isolation rate of MT organisms between sputum and stool specimens collected from the same patients. MT was isolated with Mycobacteria Growth Indicator Tube (MGIT) cultures or identified with microscopic examination of smears and Transcription Reverse-transcription Concerted reaction (TRC). Patient factors related to the MT detection in stool were also investigated. Results: Among 187 TB patients included, 60.4% (113/187) were male at the median age of 74 years (54 to 85), 7 were HIV positive, 44 had miliary tuberculosis, and 7 had intestinal tuberculosis. Positive rate of MT in stool was 12.8% (24/187) by stool Acid-fast bacilli (AFB) smear, 68.1% (98/144, 43 missing data) by TRC, and 40.6% (76/187) by culture. Multivariate logistic regression analysis revealed two independently related patient factors to MT detection in stool; presence of cavity and large area affected on chest X-ray. The adjusted odds ratio (OR) with 95% confidence interval (CI) for presence of cavity was 3.66 (95%CI 1.50-8.66), and for large affected area 4.39 (95%CI 1.22-15.7). Conclusion: MT positive rate of stool specimens is fairly high. We recommend stool examination for those who are unable to give sputum and have risks for invasive procedures.
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