Report of the First Case of Childhood Pulmonary Tuberculosis Diagnosed by the Xpert® MTB/RIF Ultra in Stool

Abstract

Introduction: Childhood tuberculosis (TB) is not a health problem in Cuba. However, in recent years, a slight increase in case notifications has been observed. Diagnosis in young children is challenging due to the paucibacillary nature of the samples and the invasive nature of specimen collection. The World Health Organization recommends the Xpert® MTB/RIF Ultra stool test as the initial test for the diagnosis of the disease in this age group. 

Objective: Presentation of the first case of childhood TB in stool using the molecular assay. 

Case presentation: A 1.5-year-old asymptomatic female patient with paternal contact with pulmonary TB (drug-sensitive), hyperergic Mantoux syndrome, and retrocardiac radiopacity on chest X-ray. A stool sample was tested using the molecular assay at the National Reference Laboratory for Tuberculosis, Pedro Kourí Institute, with a positive result (traces) for Mycobacterium tuberculosis complex and undetermined resistance to rifampicin. Shortened treatment was initiated with good tolerance, weight gain, and radiological resolution, successfully completing the treatment. 

Conclusions: Early detection of pulmonary TB allowed healthcare personnel to initiate rapid and targeted treatment, prevent serious complications, and prevent disease spread. A confirmatory diagnosis was obtained for the first time in Cuba in a child under 2 years of age. The usefulness of stool samples for diagnosing childhood TB using the Xpert® MTB/RIF Ultra assay is confirmed, without the need for invasive procedures.