Minding (and Reducing) the Detection Gap: An Algorithm to Diagnose TB With HIV Infection.

Abstract

* Abbreviation: IGRA — : interferon γ release assay Globally, an estimated 239 000 children younger than 15 years, including 39 000 with HIV infection, die of tuberculosis each year. More than 95% of these deaths occur in children who did not receive tuberculosis treatment.1 Children treated for tuberculosis have low mortality rates.2 Therefore, it is likely that the number of childhood tuberculosis deaths would decline dramatically if the case-detection ratio were improved from its current proportion of ∼1 in 3. Multiple factors contribute to this dismal case-detection rate, including the health care barriers faced by the poor and marginalized populations most affected by tuberculosis, the inability of most children to expectorate sputum for sample collection, and the paucibacillary nature of childhood tuberculosis, which leads to infrequent microbiologic confirmation. The most sensitive microbiologic test (culture) identifies Mycobacterium tuberculosis in just 25% of cases.3 Health officials in countries with high tuberculosis burden have prioritized contagious adult cases as the drivers of the tuberculosis epidemic. Consequently, front-line providers often lack adequate training to evaluate children for tuberculosis.4 Because their clinical training emphasizes tuberculosis … Address correspondence to Andrea T. Cruz, MD, MPH, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St, Suite A2210, Houston, TX 77030. E-mail: acruz{at}bcm.edu