IDDF2019-ABS-0017 Clinico-microbiological profile of gastric aspirates among pediatric pulmonary TB cases from a tertiary care hospital

Abstract

Background Childhood TB constitutes 10–20% of the total TB cases in high burden countries. The most common clinical features in pulmonary TB in children are non-productive cough, low fever and weight loss. Radiological features in pediatric pulmonary TB may also remain non-specific, most typical being hilar or paratracheal lymphadenopathy. So the diagnosis remains difficult. Microbiological confirmation remains challenging due to suboptimal pulmonary specimens in such cases. This study was aimed to analyze the clinico-microbiological profile of gastric aspirate in pediatric pulmonary TB. Methods Clinically suspected pediatric pulmonary TB cases ≤12 years of age were recruited over a period of 1 year. Gastric aspirates were processed for microbiological diagnosis. As per Revised National Tuberculosis Control Program definitions, the cases were clinically diagnosed (clinical history and Mantoux test and/or contact history and/or radiological evidence) or microbiologically confirmed [≥1 of smear/culture/Cartridge Based Nucleic Acid Amplification Test (CBNAAT)] to be pediatric pulmonary TB. Results Mean age of children in the study was 5.8 years. Of 27 cases, Mantoux test was reactive in 13 (48%), 13(48%) had a history of contact with an infectious case and BCG scar was present in 22 (81.5%) cases. Fever was the predominant symptom followed by loss of appetite, weight loss and cough. Only one case did not have suggestive chest radiography while 18 (66.7%) showed consolidation. Microbiological diagnosis could be established in 20 (74%) cases, 8 (29.6%) being smear positive, 12 (44.4%) culture positive and 17 (63%) positive by CBNAAT. Conclusions Pediatric pulmonary TB remains difficult to diagnose due to the non-specific presentation, suboptimal samples and paucibacillary nature of the disease. Though microbiological confirmation by conventional tests remains low, using CBNAAT marginally increases the positivity. An integrated approach based on history, Mantoux test, radiology and microbiology increase chances of reaching an early diagnosis. Further research is needed for newer techniques to detect and manage paucibacillary disease in children at the earliest.