Tuberculosis Diagnosis with Rapid Molecular Tests of Stool Samples in Adults with Severe Mental Illness (Review)

Tuberculosis is one of the leading causes of death worldwide. Early detection of tuberculosis is crucial for prompt initiation of treatment. Early detection of drug-resistant strains of Mycobacterium tuberculosis is particularly important to prevent their spread. However, early diagnosis can be difficult if respiratory specimens are not available for testing, such as in children, the elderly or patients with severe mental illness. Objective — to investigate the effectiveness of rapid molecular tests of stool samples in adults in diagnosis of drug-resistant tuberculosis of the lungs. Materials and methods. This study analyses literature from PubMed, namely 23 literature sources, and presents the results of our own observations about effectiveness of rapid molecular tests of stool samples in 2 adult patients with severe mental illness the diagnosis of drug-resistant tuberculosis. Results and discussion. In our own observational data, patients with severe mental illness had to be empirically prescribed first-line antituberculosis treatment due to the inability to obtain respiratory specimens for drug susceptibility testing. This treatment was not effective enough and resulted in early relapse of active tuberculosis. Obtaining respiratory specimens in patients with severe mental illness is often impossible, so finding alternative non-invasive methods of investigation is extremely important for such patients. Testing of stool samples from both patients allowed the diagnosis of multidrug-resistant tuberculosis, and adequate anti-tuberculosis treatment regimens were prescribed. Conclusions. Testing of stool samples with rapid molecular tests, namely XpertMTB/RIF and XpertMTB/XDR, is an effective alternative for diagnosis of drug-resistant tuberculosis in adult patients with inability to provide respiratory specimens, including patients with severe mental illness.