Strengthening Diagnosis of Pulmonary Tuberculosis in Children: The Role of Xpert MTB/RIF Ultra.

Abstract

* Abbreviations: BAL — : bronchoalveolar lavage IS — : induced sputum NPA — : nasopharyngeal aspirate PTB — : pulmonary tuberculosis Pediatric tuberculosis is a global concern, with children estimated to account for 10% to 15% of the overall case load, representing almost 1 million cases annually. However, modeling estimates indicate that only 30% of childhood tuberculosis cases are diagnosed and notified.1 Diagnosis of pulmonary tuberculosis (PTB) in children may be challenging because of nonspecific clinical or radiologic signs, paucibacillary disease, and low sensitivity of microbiologic diagnosis.2 However, microbiologic confirmation is needed for accurately defining the burden of disease, effective treatment (particularly for drug-resistant tuberculosis), and limiting unnecessary use of tuberculosis medication. Recent advances in specimen collection with the development of rapid molecular diagnostics have improved the ability to obtain a rapid microbiologic diagnosis. In this edition of Pediatrics , Sun et al3 report the accuracy of Xpert Mycobacterium tuberculosis and rifampicin (MTB/RIF) Ultra (Ultra), a next-generation assay on the GeneXpert platform,4 using bronchoalveolar lavage (BAL) samples. Ultra had a high sensitivity (91%) against a microbiologic reference standard of a positive culture result or smear-on-BAL result. Ultra had a nonsignificantly higher sensitivity than GeneXpert (80% vs 67%). Most strikingly, Ultra was positive … Address correspondence to Heather J. Zar, MD, PhD, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, SA MRC Unit on Child and Adolescent Health, University of Cape Town, 5th Floor, ICH Building, Cape Town 8001, South Africa. E-mail: heather.zar{at}uct.ac.za