Diagnosis Of Pediatric Tuberculosis Research Articles

Serum-Based Diagnosis of Pediatric Tuberculosis by Assay of Mycobacterium tuberculosis Factors: a Retrospective Cohort Study.

Diagnosis of pediatric tuberculosis (TB) is often complicated by its nonspecific symptoms, paucibacillary nature, and the need for invasive specimen collection techniques. However, a recently reported assay that detects Mycobacterium tuberculosis virulence factors in serum can diagnose various TB manifestations, including paucibacillary TB cases, in adults with good sensitivity and specificity. The current study examined the ability of this M. tuberculosis biomarker assay to diagnose pediatric TB using archived cryopreserved serum samples drawn from children ≤18 years of age who were screened for suspected TB as part of a prospective population-based active surveillance study. In this analysis, any detectable level of either of the M. tuberculosis virulence factors CFP-10 and ESAT-6 was considered direct evidence of TB. Serum samples from 105 children evaluated for TB (55 TB cases and 50 close contacts without TB) were analyzed. The results of this analysis yielded sensitivity of 85.5% (95% confidence interval [CI], 73.3 to 93.5). Similar diagnostic sensitivities were observed for culture-positive (87.5%; 95% CI, 67.6 to 97.3) and culture-negative (83.9%; 95% CI, 66.3 to 94.5) TB cases and for culture negative pulmonary (77.8%; 95% CI, 40.0 to 97.2) and extrapulmonary (86.4%; 95% CI, 65.1 to 97.1) TB cases. These results suggest that serum biomarker analysis holds significant promise for rapid and sensitive diagnosis of pediatric TB cases, including extrapulmonary or paucibacillary TB cases. The ability to use frozen samples for this analysis should also permit assays to be performed at central sites, without a requirement for strict timelines for sample analysis.

Clinical Profile of Pediatric Tuberculosis, Presenting to the Emergency Department of Tertiary Care Hospital in Karachi, Pakistan.

Abstract Background Tuberculosis (TB), a preventable airborne infectious disease, early detection is essential to improve health outcomes. Extent of childhood tuberculosis is unknown and is estimated to be around 6% of all incidences. Diagnosis of pediatric tuberculosis is always difficult and no age is spared, however, children <5 years are more at risk. Children frequently admitted through emergencies of hospitals with different working diagnoses and later diagnosed as tuberculous. Despite multiple studies from Pakistan; the complex and multifaceted ED presentation of childhood tuberculosis was not looked in. Primary objective was to assess the clinical profile of tuberculosis patients presenting to ED, the secondary objective was to evaluate the relation of BCG vaccination, history of contact, and measles. Methods This was a retrospective chart review of children admitted to the study center with the discharge diagnosis of Childhood Tuberculosis from June 2010 to June 2015 as per WHO criteria. Patient demographic characters, medical history, and physical examination findings in ED along with vital signs and laboratory variables will be recorded from the charts. CXR, CBC, ESR, sputum analysis, and lab other parameters were recorded from an electronic database. Results We enrolled 264 children, majority, 139 (53%) were below 5 years of age, 152 (58%) males, 112 (42%) females. BCG vaccination was given to 81 (30%) male and, 60 (23%) female children. 183 (69%) children had pulmonary symptoms, 81 (31%) had extra extrapulmonary tuberculosis. The commonest extrapulmonary manifestation was GIT 34 (13%), followed by CNS 27 (10%) cases. Cough was found in 54 (31%) followed by respiratory distress 49 (27%), almost all of them were below 5 years of age. CXR was performed in all cases, 85 (32%) didn’t have radiological findings. The frequency of BCG vaccination status, history of contact, measles about age gender, and systemic involvement was also analyzed and found significant results. 23 children, had a history of contact and measles both. Miliary was found in 6 (26%) cases, however, 22 (99%) of 23 didn’t have BCG vaccination. History of weight loss was found in 46 (33%) who either didn’t get BCG vaccination or didn’t remember (no BCG scar, 123), out of 92 children with weight loss 31 (34%) have contact history. Conclusion Diagnosing childhood tuberculosis in emergency with vague/overlapping clinical presentations is a dilemma. Clinical scoring system may not identify most cases, hence suspicion must be high in all suspected cases with prolonged history, contact tracing methods, weight loss or failure to gain weight, etc.

Comparison of clinical and laboratory profile of pulmonary and extrapulmonary tuberculosis in children: A single-center experience from India

Pediatric tuberculosis (TB) is an indicator of the recent transmission of TB in the community. However, the diagnosis of pediatric TB poses a challenge to clinicians. We aimed to evaluate and compare the clinical and laboratory profile of pulmonary TB (PTB) and extra PTB (EPTB) in children and adolescents. In this retrospective observational study, children attending the pediatric TB clinic of All India Institute of Medical Sciences, Rishikesh, from August 2015 to July 2017 were included in the study. The medical case records of patients were reviewed for demography, clinical findings, investigations, and diagnosis. The clinical and laboratory characteristics of patients with PTB and EPTB were compared. A total of 58 children included. Out of which, 33 (56.9%) had PTB, and 25 (43.1%) had EPTB. The EPTB cases included 15 (60%) pleural TB, 9 (36%) lymph node TB, and 1 (4%) TB meningitis patient. Fever, cough, and weight loss were the most common symptoms. Hilar lymphadenopathy was the most common radiological abnormality. Microbiological confirmation was possible in 54.5% of patients with PTB. Cough (aOR 70.326; 95% CI: 5.370-921.032) and microbiological confirmation (aOR 46.011; 95% CI: 2.073-1021.201) were more in PTB as compared to EPTB. PTB and EPTB are common in children and adolescents. The typical clinical manifestations and positive microbiological confirmation are less common in EPTB than PTB. TB is one of the common communicable diseases in the developing world. Diagnosis of TB in children is often challenging. Our study results help in better understanding childhood TB and EPTB clinical features and have potential to increase diagnostic yield.

Laboratory development of a simple stool sample processing method diagnosis of pediatric tuberculosis using Xpert Ultra

Stool samples are alternatives to respiratory samples for bacteriological confirmation of childhood tuberculosis but require intensive laboratory processing before molecular testing to remove PCR inhibitors and debris. We aimed to develop a centrifuge-free processing method for use in resource-limited settings based on a sucrose-flotation method that showed good sensitivity for childhood tuberculosis diagnosis.In an in vitro study using Xpert MTB/RIF Ultra on stool samples spiked with defined bacterial concentrations of Mycobacterium tuberculosis (MTB), we compared different simplification parameters to the reference sucrose-flotation method. Best methods were selected based on the rate of invalid/error results and on sensitivity, compared to the reference method on stools spiked at 103 colony forming units (CFU)/g MTB. For final selection, we tested the best parameter combinations at 102 CFU/g. Out of 13 different parameter combinations, three were tested at 102 CFU/g. The best combination used 0.5 g stool, manual shaking, no filtration, 30-min sedimentation, and a 1:3.6 dilution ratio. This method gave 10% invalid/error results and a sensitivity of 70% vs 63% at 103 CFU/g and 53% vs 58% at 102 CFU/g compared to the reference method.This pre-clinical study was able to develop a centrifuge-free processing method to facilitate stool Xpert Ultra testing.

CRISPR-based biosensing is prospective for rapid and sensitive diagnosis of pediatric tuberculosis

Pediatric tuberculosis (TB) is an important part of global TB prevention and control. Diagnosis of childhood TB still remains challenging when using conventional tests, due to the non-specific clinical manifestations and paucibacillary nature of the specimens. Thus, a sensitive, rapid and low-cost diagnostic test is of great demand. Benefiting from specific and rapid Cas-protein-based catalytic activities, CRISPR-based biosensing platforms (CRISPR platforms) are showing superiority in detecting pathogen nucleic acid traces in clinical samples. Based on their excellent sensitivity, and time and cost saved in existing research, this study aimed to highlight the potential of CRISPR platforms as a tool for diagnosing pediatric TB, and advocate for studies to evaluate its performance in specimens collected from children, especially noninvasive specimens. These platforms are also promising in identifying drug resistance and genotyping. All of the above will help early diagnosis of pediatric TB, thus guide reasonable treatment, and be significant in achieving the World Health Organization End-TB strategy.

Pediatric Tuberculosis: The Impact of "Omics" on Diagnostics Development.

Tuberculosis (TB) is a major public health concern for all ages. However, the disease presents a larger challenge in pediatric populations, partially owing to the lack of reliable diagnostic standards for the early identification of infection. Currently, there are no biomarkers that have been clinically validated for use in pediatric TB diagnosis. Identification and validation of biomarkers could provide critical information on prognosis of disease, and response to treatment. In this review, we discuss how the “omics” approach has influenced biomarker discovery and the advancement of a next generation rapid point-of-care diagnostic for TB, with special emphasis on pediatric disease. Limitations of current published studies and the barriers to their implementation into the field will be thoroughly reviewed within this article in hopes of highlighting future avenues and needs for combating the problem of pediatric tuberculosis.

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting \u2013 modern diagnostics meet age-old challenges

BackgroundDetection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings.MethodsThis was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes.ResultsAt individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical).ConclusionWe used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.

Use of Xpert MTB/RIF for diagnosis of pediatric tuberculosis in Indonesia

Background The Xpert MTB/RIF assay demonstrated a better diagnostic value than sputum smear for TB in adults and children.
 Objective To evaluate the use of Xpert MTB/RIF for TB diagnosis in children.
 Methods We conducted a prospective study in Yogyakarta, Indonesia, involving 19 primary health centers (PHCs) and one provincial hospital. Children aged 0-14 years with suspected TB who visited the study sites were screened. Subjects underwent history-taking, physical examination, tuberculin skin test, chest X-ray, as well as sputum induction for Xpert MTB/RIF assay, sputum smear, and TB culture. The diagnosis of TB was made by doctors based on the results of investigations, as follows: certain TB (bacteriological confirmation), probable TB, and possible TB.
 Results Of 80 subjects, 21 (26%) were diagnosed with TB disease (4 certain TB and 17 probable TB). Sputum induction was successfully performed in 79 children. None of the children had positive sputum smears. Mycobacterium tuberculosis was detected by Xpert MTB/RIF in 4 children, accounting for 5% of all children with suspected TB, or 19% among children with TB disease. The 4 Xpert MTB/RIF-positive subjects had severe TB disease and were rifampicin-sensitive.
 Conclusion Xpert MTB/RIF may improve case finding among children with severe TB disease with negative sputum smear.

Improving pediatric TB diagnosis in North Kivu (DR Congo), focusing on a clinical algorithm including targeted Xpert MTB/RIF on gastric aspirates

BackgroundThe incidence of tuberculosis (TB) in the Democratic Republic of the Congo (DRC) is 323/100,000. A context of civil conflict, internally displaced people and mining activities suggests a higher regional TB incidence in North Kivu. Médecins Sans Frontières (MSF) supports the General Reference Hospital of Masisi, North Kivu, covering a population of 520,000, with an elevated rate of pediatric malnutrition. In July 2017, an adapted MSF pediatric TB diagnostic algorithm, including Xpert MTB/RIF on gastric aspirates (GAs), was implemented. The aim of this study was to evaluate whether the introduction of this clinical pediatric TB diagnostic algorithm influenced the number of children started on TB treatment.MethodsWe performed a retrospective analysis of pediatric TB cases started on treatment in the inpatient therapeutic feeding centre (ITFC) and the pediatric ward. We compared data collected in the second half (July to December) of 2016 (before introduction of the new diagnostic algorithm) and the second half of 2017. For the outcome variables the difference between the two years was calculated by a Pearson Chi-square test.ResultsIn 2017, 94 GAs were performed, compared to none in 2016. Twelve percent (11/94) of samples were Xpert MTB/RIF positive. Sixty-eight children (2.9% of total exits) aged between 3 months and 15 years started TB treatment in 2017, compared to 19 (1.4% of total exits) in 2016 (p 0.002). The largest increase in pediatric TB diagnoses in 2017 occurred in patients with a negative Xpert MTB/RIF result, but clinically highly suggestive of TB according to the newly introduced diagnostic algorithm. Fifty-two (3.1%) children under five years old started treatment in 2017, as compared to 14 (1.3%) in 2016 (p 0.004). The increase was less pronounced and not statistically significant in older patients: sixteen children (2.6%) above 5 years old started TB treatment in 2017 as compared to five (1.3%) in 2016 (p 0.17).ConclusionAfter the introduction of an adapted clinical pediatric TB diagnostic algorithm, including Xpert MTB/RIF on gastric aspirates, we observed a significant increase in the number of children – especially under 5 years old – started on TB treatment, mostly on clinical grounds. Increased ‘clinician awareness’ of pediatric TB likely played an important role.

Expression levels of candidate circulating microRNAs in pediatric tuberculosis

ABSTRACT Tuberculosis (TB) is a preventable and curable disease, but increased mortality and morbidity associated with TB is one of the leading causes of deaths worldwide. MicroRNAs (miRNAs) are small, non-coding RNAs known to regulate the host immune response against TB. We investigated the expression profile of candidate circulating miRNAs, which could be used as a blood biomarker for the effective diagnosis of pediatric tuberculosis. A cross-sectional comparative study was conducted, including 30 children with active-TB and 30 healthy controls (HC) in a tertiary care hospital in Puducherry. We used the SYBR green-based miScript qRT-PCR assay to analyze the expression levels of miRNAs in plasma. Further, we used the receiver operating characteristic curve (ROC) to evaluate the diagnostic value of miRNAs. Active-TB included 25 (83.3%) pulmonary TB and 5 (16.7%) extrapulmonary TB cases. We found a significant upregulation of miR-21, miR-29a, miR-31, miR-155, and downregulation of miR-146a in children with active-TB compared to HC. The ROC analysis showed an excellent diagnostic value of miRNAs as follows: miR‑31> miR‑155> miR‑146a with AUC of (95% CI) miRNAs 0.978, 0.953, and 0.903, respectively. Altered circulating miRNA expression levels could be involved in the dysregulation of the host immune response to TB. The ROC analysis indicated that miRNAs miR-31, miR-155 and miR-146a could be effective diagnostic biomarkers for the detection of active-TB in children.

Diagnostic value of polymerase chain reaction targeting insertion sequence IS1081 for the diagnosis of pediatric tuberculosis

Background: Aim of this study was to evaluate the efficacy of PCR targeting IS1081in diagnosis of pediatric tuberculosis and compare the results with MGIT culture.Methods: This prospective study was conducted in the department of pediatrics, S.N. medical college, Agra. 100 subjects (28 pulmonary 72 extra pulmonary) were registered in study. The specimens obtained from these cases were subjected to Ziehl–Neelsen staining (ZN), MGIT 960 TB culture and PCR targeting insertion sequence IS1081. Sensitivity, specificity, PPV and NPV of PCR were calculated in pulmonary and extra pulmonary specimens. The results of PCR IS1081 were compared to MGIT culture.Results: Microscopy with ZN staining was positive in 12 (12%) samples. MGIT culture was positive in 44% samples with maximum positivity in sputum (70%). PCR IS1081 has shown 93.3% sensitivity in pulmonary tuberculosis, while PCR IS1081 has shown 93.1% sensitivity in extra pulmonary tuberculosis. In diagnosis of childhood tuberculosis PCR IS1081 was found to be statistically significant (p value <0.05) as compared with MGIT culture. Result was statistically significant (p value <0.05) in CSF samples only.Conclusions: The study concluded that the PCR targeting sequence IS1081 technique is the most sensitive technique for a quick identification of MTB in pulmonary and extra pulmonary tuberculosis.

Evaluation of pulmonary tuberculosis diagnostic tests in children and adolescents at a pediatric reference center

IntroductionThis study evaluates the performance of individual and combinations tests used for pediatric tuberculosis diagnosis at a reference center. Materials and MethodsDiagnostic test outcomes from children with presumed pulmonary tuberculosis evaluated from January 2005 - July 2010 were compared to a standard diagnosis made by an expert panel of physicians. ResultsPresence of at least one sign/symptom, history of contact, or abnormal chest X-ray (aCXR) individually showed the highest sensitivity (85.7%). While the combination of history of contact, at least one sign/symptom, positive tuberculin skin test, and aCXR had low sensitivity of 20%, but the specificity and a positive predictive value were 100%, respectively. The combination of tests used in the International Union Against Tuberculosis and Lung Disease and the Brazilian Ministry of Health systems showed sensitivity of 28.6% and 71.4% and specificity of 95.8% and 97.0%, respectively. ConclusionsIn the absence of a gold standard, the combination of clinical history, tuberculin skin test, and aCXR, as well as the Brazilian scoring system serve as simple, low-cost approach that can be used for pediatric TB diagnosis by first-contact care providers.

Utility of Xpert MTB/RIF Assay for Diagnosis of Pediatric Tuberculosis Under Programmatic Conditions in India

Tuberculosis (TB) diagnosis in children still remains a challenge in developing countries. We analyze the performance of Xpert MTB/RIF assay for the diagnosis of pediatric TB under programmatic conditions. We retrospectively analyzed the performance of Xpert MTB/RIF assay from February 2016 to March 2018. A total 2678 samples from TB suspects below 14 years were received in the laboratory and were frontline tested by Xpert MTB/RIF assay according to the manufacturer’s instructions. If sample was sufficient, the smear microscopy and culture were performed as per standard World Health Organization’s guidelines. The smears and cultures were performed in 2178 and 588 samples, respectively. Among 2678 samples, 68 were rejected, Xpert MTB/RIF assay was positive in 357/2610 (13.6%) cases, while the smear was positive in 81/2178 (3.3%) cases. The sensitivity of smear and Xpert MTB/RIF when compared with culture was 24.6% (14.1–37.8%) and 81% (68.6–90.1%), respectively. The diagnostic accuracy of Xpert MTB/RIF and smear was 97.1% and 92.2%, respectively. Thirty samples (8.5%) were detected as rifampicin resistance by Xpert MTB/RIF assay. The Xpert MTB/RIF increased the detection rate up to fourfold when compared with smear microscopy. Xpert MTB/RIF assay is the most rapid, sensitive, and specific method for microbiological confirmation and rifampicin resistance detection in pediatric tuberculosis.

Diagnosis of pulmonary tuberculosis from gastric aspirate samples in nonexpectorating pediatric patients in a tertiary care hospital.

The aim of this study was to assess the utility of Xpert assay, Ziehl-Neelsen (ZN) staining, and Mycobacteria Growth Indicator Tube (MGIT™) culture for diagnosis of pediatric pulmonary tuberculosis from gastric aspirate (GA) samples and to compare Xpert assay and ZN staining with MGIT rapid liquid culture. GA samples from 210 nonexpectorating children, aged between 6 months to 12 years, presenting to the pediatric out-patient department (OPD) with clinical suspicion of tuberculosis (TB) were collected. The samples were tested by GeneXpert, ZN staining, and MGIT liquid culture. GeneXpert is a more sensitive method for rapid and early diagnosis of pediatric TB when compared with microscopy.

Diagnostic accuracy of CBNAAT (Gene-Xpert) Vs liquid culture in clinically diagnosed presumptive childhood tuberculosis admitted in Pt. J.N.M. Medical College & Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur (C.G.)

Background: Paediatric tuberculosis comprises 10% of all tuberculosis in developing countries. Smear microscopy is diagnostic for Pulmonary TB whereas for extra-pulmonary TB, CBNAAT (Gene-Xpert) and liquid-culture are available choices. Objectives: To establish the comparative diagnostic efficacy of CBNAAT and Liquid-culture in clinically presumptive childhood Tuberculosis. Outcome: Assess sensitivity and specificity of CBNAAT Vs Liquid-culture in clinically diagnosed presumptive childhood tuberculosis. Material & Method: After approval from institutional ethical committee this Cross-sectional study was performed in department of paediatrics Pt. J. N. M. Medical College, Raipur C.G. Total 97 paediatric presumptive TB cases were enrolled for systematic screening from June-2017 to July-2018. Samples were collected and analysed by CBNAAT and liquid-culture. Data for Diagnostic efficacy of both techniques were analysed with appropriate statistical method. Results: Among study subject group 41.2% belongs to 11-15 age-group and 53.6% were female. Majority of them belongs to joint family (81.4%) and low-socioeconomic (85.6%) status. Among 97 presumptive cases CBNAAT was positive in 24.7% whereas liquid-culture was positive in 22.7%. CBNNAT has sensitivity (100%) and specificity (98.61%) when compared with liquid-culture as gold-standard. It has 95.65% positive and 100% negative predictive values. CBNAAT had 100% of sensitivity and specificity in diagnosis of abdominal-tuberculosis and TB-meningitis. In Pulmonary-TB diagnosis its specificity reduced to 98%. Conclusion: CBNAAT is equally efficacious diagnostic tool to diagnose clinically presumptive TB cases and it should be used in public health system for early diagnosis of paediatric tuberculosis.

Mycobacterial Blood Culture for Diagnosis of Tuberculosis in Vietnamese Children.

Diagnosis of pediatric tuberculosis is notoriously difficult. We investigated the additional yield of blood culture in hospitalized children in Vietnam. Among 554 enrolled clinically suspected patients, an additional 6 cases were diagnosed, while the incremental cost per case was USD500. Addition of blood culture is therefore not recommended for our total patient population, but may be considered in specific groups.

Health care worker perspectives on TB case finding and HIV services among pediatric TB patients in Tanzania.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) infection in children are of concern due to the high morbidity and mortality they engender. Tanzania is working to improve TB and HIV case identification and treatment, as well as linkage of TB and HIV care in pediatric patients.METHODS: In-depth interviews were conducted in March 2016 at 10 high TB burden clinics in five districts of Tanzania to identify the barriers to pediatric TB diagnosis and HIV care. Health care workers (HCWs) at TB clinics who provided informed consent were administered interviews which were analyzed.RESULTS: Of 41 HCWs interviewed, 26 reported receiving pediatric TB training. Barriers to TB diagnosis included low community awareness, stigma and late presentation to the clinic. Barriers to HIV testing included children attending the TB clinic with someone who was not their parent/guardian and shortages of HIV rapid test kits. HCWs stressed the need for improved community education because it was perceived that some caregivers did not understand the importance of prompt TB and HIV treatment in children (although most were eager for a resolution of their child's illness).CONCLUSIONS: Efforts are needed to ensure effective TB and HIV diagnosis and treatment of children, provision of broader HCW and community education, enhanced TB-HIV contact tracing, and ensuring a continuous supply of HIV rapid test kits.

Prospective study to find out the role of cerebrospinal fluid examination by cartridge-based nucleic acid amplification test and culture and sensitivity as a diagnostic method in childhood central nervous system tuberculosis

Introduction: Central nervous system (CNS) tuberculosis (TB), particularly tuberculous meningitis, is the severest form of Mycobacterium tuberculosis (MTB) infection causing severe neurological defects or even death. The recent introduction of cartridge-based nucleic acid amplification test (CBNAAT) has significantly transformed the diagnostics of TB in adults, but its application for the diagnosis of pediatric TB is under evaluation. Objective: This study was conducted by for cerebrospinal fluid (CSF) examination in the detection of MTB by the culture and sensitivity and CBNAAT in the diagnosis of childhood CNS TB. Methods: A prospective hospital-based study was conducted from July 2017 to June 2018 in the pediatric department of a tertiary care unit. A total of 65 randomly selected patients, suspected of CNS TB, were included in this study. CSF was tested for CBNAAT and culture and sensitivity other routine investigations such as specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CBNAAT and culture and sensitivity. Mantoux test was also performed, and the statistical analysis was performed using Chi-square test. p=0.05 was considered to be statistically significant. Results: Culture positive TB was found in 26 out of the 65 children. The sensitivity, specificity, PPV, and NPV for CBNAAT and culture and sensitivity were 65.71%, 90.00%, 88.46%, and 69.23%, respectively. CBNAAT was detected to be more in 12 TB cases and was more sensitive than culture and sensitivity. Positive history of contact (p=0.04), reactive Mantoux test (p<0.005), presence of Bacillus Calmette Guerin (BCG) scar (p=0.02), and low socioeconomic status were independently associated with a positive CBNAAT result. Conclusion: Analysis of CSF sample with CBNAAT is a sensitive and specific method for rapid diagnosis of CNS TB in children. Compared to culture and sensitivity, CBNAAT offers better sensitivity and its scale-up will improve access to CNS TB diagnostics in children. Although a negative CBNAAT does not rule out TB.

Diagnosis of paediatric tuberculosis by cartridge based nucleic acid amplification test and its effectiveness as compared to the other conventional diagnostic methods

Background: Childhood TB constitutes 10-20% of all TB cases in high burden countries like India and accounting for 8-20% of TB related deaths. Diagnosis of TB in children is difficult. One test, CBNAAT which was recently endorsed by WHO has the potential to lead a revolution in diagnosis of active TB disease.Methods: A cross sectional study in SCB MCH and SVPPGIP, Cuttack in all the suspected TB patients admitted during the period from January 2016 to October 2017.Results: A total of 100 suspicious patients admitted to the Department of Pediatrics in SCB MCH and SVPPGIP during the study period. Of these 45 were diagnosed TB and rest others were diagnosed otherwise than TB. Diagnosis of TB was established on basis of Microscopy, CBNAAT, culture, biochemistry, cytology, clinical findings, neuroimaging, FNAC/biopsy, USG abdomen. Out of 45 TB patients 30 were CBNAAT positive taking the body fluid samples other than blood, urine and stool with a sensitivity of 66.7% and specificity of 100%. Out of 45 TB patients 14 were having ZN Smear positive taking the same fluid sample with a sensitivity of 31.1% and specificity of 100%. Whereas out of these 45 TB patients 32 were MGIT culture positive taking the same sample with a sensitivity of 71.1% and specificity of 100%. When diagnostic performances of CBNAAT and MGIT culture were compared, it was found to be statistically insignificant with a P value 0.54.Conclusions: The CBNAAT is able to confirm a diagnosis of TB with 66.7% sensitivity and 100% specificity within 2 hours. We can use CBNAAT as a diagnostic method as it provides rapid result and simultaneous better sensitive result, it can be helpful in starting ATT in sick patients and also in outdoor patients.

Early diagnosis of smear-negative childhood pulmonary tuberculosis and its substantial yield in gastric lavage/aspirates through cartridge-based nucleic acid amplification test (Xpert Mycobacterium tuberculosis/rifampicin assay)

Introduction: Tuberculosis (TB) still remains the major public health threat in India. Early diagnosis is a priority as any delay may complicate the prognosis further leading to the failure of an effective control. India accounts for 6% incidence of pediatric TB cases in a population that has 40% as estimated latent TB cases. Gastric Lavage /aspirates were taken under study for pediatric patients as key population. Collection of sputum samples from the pediatric patients has been very difficult. The most common implementation of cartridge-based nucleic acid amplification tests (CBNAATs) in diagnosis of pediatric TB has augmented the detection rates. As a mandate for universal drug sensitivity, testing of smear-negative pediatric samples is set as a priority. The program included the smear-negative pulmonary samples contributing to high yield after sputum includes induced sputum, bronchoalveolar lavage, gastric aspirate, and gastric lavage. The study involves an analysis probing into the percentage contribution of these samples and the substantial yields of gastric lavage among these samples. Methods: Pulmonary pediatric samples were tested on CBNAAT by Xpert Mycobacterium tuberculosis/rifampicin (RIF) (Cepheid) based on the manufacturer's instruction. All necessary aseptic measures were taken. The data were captured in the Xpert software automatically during the tests and exported to the Microsoft Excel sheets for further analysis. A defined study design against each and every objective was set up. Results: From earlier studies, it was found that a point prevalence of 6%–7% of pediatric TB exists among the tested specimens every quarter. The periodic prevalence was found to be 5%, and the incidence rates ranged from 4.5% to 5%. RIF resistance detection showing a seasonal variation ranged from 13% to 15% among the CBNAAT-positive cases. Conclusions: The study concluded that more skilled collection centers for biological specimens are required to address the undetected pulmonary TB cases among the pediatric age group, especially below 6 months of age. About 5% prevalence and around 4.9% incidence is an alarming situation in the TB control scenario of West Bengal. Gastric lavage showed a major detection in children aged below 6 months of whom collecting sputum samples were difficult. This prompted suboptimal detection levels due to the dearth of sample collection modalities at the peripheries.