Diagnosis Of Tuberculosis In Children Research Articles

GeneXpert MTB/RIF and Mycobacterium tuberculosis Sputum Culture in Establishing the Diagnosis of Pulmonary Tuberculosis and Rifampicin Resistance in Suspected Childhood Pulmonary Tuberculosis in Soetomo Hospital

The diagnosis of childhood tuberculosis remains a challenge worldwide. The GeneXpert MTB/RIF test, a rapid Mycobacteria tuberculosis diagnostic tool, was recommended for use in children. No pediatric studies of GeneXpert MTB/RIF assessing pulmonary tuberculosis within a hospital setting has been done in Indonesia. We evaluated the performance of the GeneXpert MTB/RIF test compared with sputum culture on Lowenstein-Jensen (LJ) for the diagnosis of childhood pulmonary tuberculosis. This study was conducted in pediatric respirology inpatient and outpatient Dr. Soetomo Hospital, a tertiary care facility in Surabaya between June and August 2015 with a cross-sectional design. We consecutively enrolled 27 children aged 3 months to 14 years who had history of close contact with adult tuberculosis patients and showed symptoms of pulmonary tuberculosis. Sputum collection was performed by induced sputum and three examination methods were performed (microscopic, GeneXpert MTB/RIF and sputum culture) simultaneously followed by a drug sensitivity test for specimens detected with MTB growth. The GeneXpert MTB/RIF test had a sensitivity of 100% (95% CI 100-100) and a specificity of 95% (95% CI 85-100). The positive predictive value for diagnosing pulmonary TB was 89% (95% CI 68-100), the negative predictive value was 100% (95% CI 100-100) and positive likelihood ratio was 20 (95% CI 2.82-128). The GeneXpert MTB/RIF test on one sputum sample rapidly and correctly identified all children with culture-confirmed pulmonary tuberculosis with high specificity. Similar results were obtained between GeneXpert MTB/RIF and sputum culture based on age groups and clinical manifestations. Rifampicin resistance were both detected in GeneXpert MTB/RIF and MTB sensitivity test

Isolation of Mycobacterium tuberculosis from inner cheek and tongue of children with presumptive tuberculosis in a community, southwestern Nigeria

Background: Burden of tuberculosis (TB) is widespread worldwide with children accounting for a major proportion of the disease, especially in endemic areas of the world. Accurate diagnosis of childhood TB remains a major challenge, particularly in developing countries where active case finding programmes and sensitive diagnostic tools are lacking or inadequate. This is exacerbated by inherent inadequacies associated with difficulties related to sputum collection in children.This study aimed at exploring a less invasive, novel diagnostic matrix of inner cheek and tongue swab samples for diagnosing childhood tuberculosis. Methods and materials: Children of less than 15 y who are presumptive TB cases were screened during an active case finding project in a rural pastoralist community in Ibarapa Area, Oyo State, Nigeria. Inner cheek and tongue swab samples were collected from each child and subjected to bacteriological processing and culture. Molecular analyses (genus and deletion typing techniques) were used for confirmation and identification of the isolates. Results: Overall, a total of 176 children were sampled with almost same number of males and females. Up to 39.8% (70/176) were within 5–9 y age range. A culture positivity of 5.1% (9/176) and 6.8% (12/176) were recorded for cheek and tongue swabs, respectively. Using molecular techniques, six and four Mycobacterium tuberculosis isolates from inner cheek and tongue swab samples were identified, respectively. Conclusion: Detection of mycobacteria specie from inner cheek and tongue swab from children with presumptive TB is a positive step towards improving TB diagnosis through non-invasive, non-viscous and easy to assess means of diagnosing childhood TB. This becomes very important considering the challenges associated with diagnosis of childhood TB and the endemicity of the disease in Nigeria. Finally, we propose further investigations to explore the full spectrum of diagnostic utility of this non-invasive method as an add-on for childhood tuberculosis.

Integration of metabolomics and transcriptomics reveals novel biomarkers in the blood for tuberculosis diagnosis in children

Pediatric tuberculosis (TB) remains a major global health problem. Improved pediatric diagnostics using readily available biosources are urgently needed. We used liquid chromatography-mass spectrometry to analyze plasma metabolite profiles of Indian children with active TB (n = 16) and age- and sex-matched, Mycobacterium tuberculosis-exposed but uninfected household contacts (n = 32). Metabolomic data were integrated with whole blood transcriptomic data for each participant at diagnosis and throughout treatment for drug-susceptible TB. A decision tree algorithm identified 3 metabolites that correctly identified TB status at distinct times during treatment. N-acetylneuraminate achieved an area under the receiver operating characteristic curve (AUC) of 0.66 at diagnosis. Quinolinate achieved an AUC of 0.77 after 1 month of treatment, and pyridoxate achieved an AUC of 0.87 after successful treatment completion. A set of 4 metabolites (gamma-glutamylalanine, gamma-glutamylglycine, glutamine, and pyridoxate) identified treatment response with an AUC of 0.86. Pathway enrichment analyses of these metabolites and corresponding transcriptional data correlated N-acetylneuraminate with immunoregulatory interactions between lymphoid and non-lymphoid cells, and correlated pyridoxate with p53-regulated metabolic genes and mitochondrial translation. Our findings shed new light on metabolic dysregulation in children with TB and pave the way for new diagnostic and treatment response markers in pediatric TB.

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.

Clinical profile of pediatric patients with tuberculosis in a tertiary care centre in India

Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.

Use of Xpert Contributes to Accurate Diagnosis, Timely Initiation, and Rational Use of Anti-TB Treatment Among Childhood Tuberculosis Cases in South Central Ethiopia.

BackgroundChildhood tuberculosis (TB) was under-prioritized, and only 15% of childhood TB cases are microbiologically confirmed. Hence, most childhood TB diagnoses are made on a clinical basis and prone to over- or under-treatment. Xpert is a rapid method for the diagnosis of childhood TB with high sensitivity.ObjectiveTo assess the use of Xpert for accurate diagnosis, timely initiation, and rational use of anti-TB treatment among childhood TB.MethodsIn 2016, the hospital facilitated the installation of the Xpert machine. We reviewed data trends over four consecutive years; two years before the arrival of the machine and two years following the implementation of Xpert. Data were extracted retrospectively from electronically stored databases and medical records and entered to SPSS 21 for analysis.ResultsIn the pre-intervention period (2014–2015), 404 cases of children presenting with symptoms or signs suggestive of TB (“presumptive TB”) were evaluated using AFB microscopy. A total of 254 (62.8%) TB diagnoses were made, of which 54 (21.3%) were confirmed by smear AFB while 200 (78.7%) were treated as smear-negative TB cases. The mean waiting time to start anti-TB treatment was 6.95 days [95% CI (3.71–10.90)]. During the intervention period (2016–2017), 371 children with presumptive TB were evaluated using Xpert. A total of 199 (53.6%) childhood TB cases were notified, of which 88 (44.2%) were Xpert positive and 111 (55.8%) were treated as Xpert-negative probable TB cases. The tendency to initiate anti-TB treatment for unconfirmed TB cases was reduced by a third. Compared with smear AFB, Xpert improved accuracy of diagnosing pediatric TB cases two-fold. The average waiting time to start anti-TB treatment was 1.33 days [95% CI (0.95–1.71)]. There was a significant reduction in the waiting time to start anti-TB treatment, with a mean time difference before and during intervention of 5.62 days [95% CI (1.68–9.56)].ConclusionXpert use was associated with a significant increase in the accuracy of identifying confirmed TB cases, reduced unnecessary anti-TB prescription, and shortened the time taken to start TB treatment.

Combined Use of Gastric Aspirate and Induced Sputum Increases the Microbiological Diagnosis of Tuberculosis in Children

Abstract Objective Diagnosis of pulmonary tuberculosis (PTB) in pediatrics is a challenge due to the paucibacillary condition of the disease in this population, low sputum expectoration, and diverse unspecific symptomatology. Mycobacterial isolation through culture remains a priority. The objective of this study is to explore gastric aspirates and induced sputum techniques in the pediatric population for positivity on mycobacterial cultures. Methods In this observational analytical study, two temporal groups were evaluated. A comparison of the isolation rate defined as positive culture confirmation by gastric aspirate (GA), induced sputum (IS), or combination of these both techniques in children under 10 years of age. The study included 86 children, 37 in the first evaluated study group and 49 in the second group. Discussion Culture positivity was 10.8 and 30.6% for the first and second case series, respectively. These findings showed that the combination of GA and IS in two consecutive days yielded a significantly higher detection rate to confirm pulmonary tuberculosis by culture. Conclusion The combination of GA plus IS samples for collection of M. tuberculosis culture can be a useful, nonexpensive, and safe diagnostic tool in low- and middleincome countries to diagnose tuberculosis in children.

Interferon-g-Inducible Protein 10 for Diagnosis of Tuberculosis in Children

BACKGROUND: The diagnosis of tuberculosis (TB) in children is challenging by the absence of a practical gold standard. Interferon (IFN)-ginducible protein 10 (IP-10) is a chemokine that may serve as the leading candidate marker in child TB diagnosis. The aim of this study is to assess the diagnostic value of IP-10 in the diagnosis of TB in children.METHODS: We recruited eligible symptomatic and asymptomatic children aged <15 years actively by contact investigation and passively from inpatient and outpatient clinics in two hospitals, in Yogyakarta, Indonesia. We conducted clinical examination and chest X-ray in all eligible children. Sputum smear and the rapid molecular TB test were performed in children with TB symptoms. All participants underwent blood sampling for IFN-g Release Assay and IP-10 test.RESULTS: A total of 79 children were recruited to this study. Twelve children were with TB disease, 16 with latent TB infection (LTBI), 40 were TB-exposed only and 11 were non-TB. Children with evidence of TB infection either with TB disease or LTBI had higher levels of antigen-stimulated IP-10 compared to non-infected children, both TB exposed only and non-TB (p=0.000). A cut-off 408.74 pg/mL for antigen-stimulated IP-10 showed high diagnostic accuracy for diagnosis of TB infection (AUC: 0.97, 95% CI: 0.92-1.00, sensitivity: 92.3%, and specificity: 91.9%). However, the stimulated levels of IP-10 between children with TB disease and LTBI were not significantly different (p=0.268).CONCLUSION: IP-10 performed well to diagnose TB infection in children. However, it cannot be used to differentiate TB infection from TB disease.KEYWORDS: IFN-g, IP-10, latent TB, active TB, children

Antibody-Secreting Cells To Diagnose Mycobacterium tuberculosis Infection in Children in Pakistan

Reliance on microbiologic methods to diagnose Mycobacterium tuberculosis infection is a suboptimal approach for children due in part to the paucibacillary nature of the disease. A blood-based biomarker assay, such as the mycobacterial-antibody-secreting cell (MASC) assay, could be a major advance for the field of study of pediatric tuberculosis (TB). Children <15 years of age with clinical concern for TB and age-matched children with no concern for TB were enrolled from outpatient clinics in Karachi, Pakistan. MASC, ferritin, and C-reactive protein (CRP) assays were performed, and results were compared among cases and controls, as well as among children with a case definition of "confirmed TB," "probable TB," or "possible TB." MASC responses were significantly higher among children with TB than among controls (0.41 optical density [OD] versus 0.28 OD, respectively, P < 0.001), and the differences were largely driven by the data from children with confirmed TB (P = 0.002). Ferritin and CRP values were significantly higher among those with confirmed TB than among those with the other disease states and controls (P = 0.004 and P = 0.019, respectively). The use of the MASC assay as a blood-based biomarker for TB disease shows some promise among children with microbiologically confirmed disease; however, the performance characteristics for the majority of young children with unconfirmed TB were suboptimal in this cohort.IMPORTANCE Tuberculosis (TB) in children represents a missed opportunity for diagnosis and preventive therapy. The magnitude or burden of disease in children is not fully understood due to our limitations with respect to exploring sensitive diagnostic algorithms. In a setting of TB endemicity in Pakistan, we carried out a proof-of-concept study to evaluate for the first time the performance of B cell analyses by the use of well-defined diagnostic criteria and NIH consensus guidelines as "culture-confirmed," "probable," and "possible" TB groups. In contrast to detection of serum antibody, we focused on mycobacterial-antibody-secreting cell (MASC) detection as a marker of active disease in children with a strong suspicion of TB. Further work exploring a larger panel of inflammatory biomarkers and enrichment of B cells with the objective of increasing the sensitivity of the current MASC assay would lead to the development of a field-friendly assay for timely diagnosis of childhood TB.

Xpert MTB/RIF assay for diagnosis of extrapulmonary tuberculosis in children: a systematic review and meta-analysis

BackgroundThe Xpert® MTB/RIF assay (Xpert; Cepheid, Sunnyvale, CA, USA) is a cartridge-based nucleic acid amplification assay for rapidly diagnosing tuberculosis and assessing antibiotic sensitivity. Although previous evidence supports the use of Xpert for diagnosing extrapulmonary tuberculosis (EPTB) in adults, information regarding the accuracy of Xpert for EPTB only in children is lacking. This meta-analysis was performed to assess the accuracy of Xpert for detecting EPTB in children.MethodsWe searched the MEDLINE, EMBASE, and Cochrane Infectious Diseases Group Specialized Register from January 1, 2010 to July 16, 2019 for studies of the diagnostic performance wherein Xpert was analyzed against cultures or composite reference standards for < 18-year-old children with EPTB.ResultsIn only pediatric studies, 8 studies including 652 samples were selected. The pooled sensitivity and specificity of Xpert for all samples were 71% (95% CI 0.63–0.79) and 97% (95% CI 0.95–0.99), respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.89. For lymph node tissues or aspirates, the pooled sensitivity and specificity of Xpert were 80% (95% CI 0.70–0.88) and 94% (95% CI 0.89–0.97), respectively; for cerebrospinal fluid (CSF), these values were 42% (95% CI 0.22–0.63) and 99% (95% CI 0.95–1.00), respectively.ConclusionOverall, Xpert displayed high specificity but modest sensitivity across various samples for diagnosing pediatric EPTB compared to the composite reference standard. Xpert sensitivity varied with the sampling site and was especially lower in CSF samples. Positive Xpert results may be considered to indicate a presumptive case of pediatric EPTB, whereas negative test results indicate that the possibility of pediatric EPTB should not be excluded.

Evaluation of clinical and laboratory characteristics of childhood tuberculosis.

Aim:Tuberculosis is one of the oldest and most contagious diseases of human history. One- quarter of the world’s population is infected with the tuberculosis bacillus. Childhood tuberculosis does not have a standard clinical and radiologic description. Herein, we aimed to evaluate the clinical, laboratory, and radiologic findings of childhood tuberculosis.Material and Methods:The medical records of 216 patients hospitalized and treated with a diagnosis of TB between January 2015 and July 2019 in the Division of Pediatric Infectious Diseases in our hospital, were examined retrospectively.Results:One hundred twenty-nine (59.7%) of 216 patients who were diagnosed as having TB were female and 87 (40.3%) were male. The age distribution of the patients was 12.3 (range, 0.33–18) years. One hundred sixty-nine patients (78.2%) had pulmonary, 34 (15.7%) had extrapulmonary, 13 had (6%) both pulmonary and extrapulmonary. One hundred forty-three (66.2%) patients had tuberculin skin test positivity. Acid-resistant bacteria were observed in 46 (21.3%) body fluid samples, and culture positivity was observed in 42 (19.4%) samples. The association of pulmonary tuberculosis and extrapulmonary tuberculosis was found with a higher rate in individuals who lived on minimum wage and in patients who had growth and developmental retardation (p=0.001, p<0.001). The hospitalization time was longer in these patients (p=0.027). The hemoglobin and sodium levels were significantly lower in patients who had extrapulmonary tuberculosis (p=0.044, p=0.002).Conclusion:Although the diagnosis of childhood tuberculosis is difficult due to the nonspecific signs and symptoms, it is a preventable and treatable disease.

The use of Gene-Xpert MTB RIF in the diagnosis of extrapulmonary tuberculosis in childhood and adolescence.

INTRODUCTION: Gene-Xpert MTB RIF (Xpert) is based on nucleic acid amplification by real-time polymerase chain reaction, which allows for the identification of Mycobacterium tuberculosis and rifampin resistance. We describe the use of Xpert for extrapulmonary tuberculosis (EPTB) in children and adolescents. METHODS: A case series of two reference centers in Rio de Janeiro from 2014-2019. RESULTS: The final diagnosis of EPTB was established in 11/36 (31%) patients, with five cases detectable by Xpert. For lymph node evaluation (9/11), diagnosis by Xpert occurred in 5/9 patients, all with caseous aspects. CONCLUSIONS: Xpert can facilitate the rapid diagnosis of lymph node tuberculosis.

The use of GeneXpert Mycobacterium tuberculosis/rifampicin assay in diagnosis of pulmonary tuberculosis in children

Introduction Rapid diagno sis of tuberculosis (TB) is essential for early disease management. GeneXpert (GX) test is a novel rapid diagnostic modality. In this study, we aimed to evaluate the diagnostic role of GX test in diagnosing pulmonary tuberculosis (PTB) in children as well as detection of rifampicin (RIF) resistance. Patients and methods This was a cross-sectional study that included 80 patients suspected to have PTB based on clinical data together with at least one of the followings: a positive tuberculin skin test or QuantiFERON-TB Gold In-Tube test result, a positive blood TB PCR result, or a positive Ziehl–Neelsen staining result. Results PTB was more common in older females. Extrapulmonary manifestations and hilar lymphadenopathy were more frequent in younger age. Both positive tuberculin skin test and positive GX were more frequent in older age. Positive GX was found in 30 (37.5%) cases, and RIF resistance was detected in two (6.6%) of them. Positive GX results were more frequent in sputum than gastric aspirate samples. Positive GX results were more frequent with absent Bacillus Calmette–Guerin scar, and with hemoptysis, failure to thrive, cavitary lung lesions, and lower mean hemoglobin. Conclusion GX detects many more cases than blood PCR and Ziehl–Neelsen stain. GX had 70% sensitivity and 95% specificity in diagnosing PTB, with overall diagnostic accuracy of 86.67%, with better performance in older children who could expectorate. RIF resistance was ∼6.6%.

Comparison between Quanti-FERON-TB Gold In-Tube test and tuberculin skin test for diagnosis of latent tuberculosis in children: A cross-section study

Objective: To compare Quanti-FERON-TB Gold In-Tube (QFT- GIT) test and tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection in children. Methods: In this cross-sectional study, 64 participants who were between 3 months and 14 years old and had close contact with smear-positive pulmonary tuberculosis were included. Both QFT- GIT test and TST were done and the results were analyzed by SPSS software and Kappa test. Results: The distribution of gender and age according to QFT-GIT and TST results were matched (P>0.05). Overall agreement between QFT-GIT and TST for diagnosis of latent tuberculosis infection in children was 75%. In addition, the contingency coefficient was 0.257, and the Kappa measure of agreement was 0.246 (P=0.034). Conclusions: Compared to TST, QFT-GIT shows no apparent advantage for diagnosis of latent tuberculosis infection in children.

Cartridge Based Nucleic Acid Amplification Test: Utility as Diagnostic Modality in Clinically Diagnosed Childhood Tuberculosis

Introduction: Tuberculosis (TB) remains one of the deadliest communicable diseases worldwide. The introduction of early and rapid diagnostic test such as Cartridge Based Nucleic Acid Amplification Test (CBNAAT) creates opportunities for improvement in early and fast detection of TB and drug-resistance. Aim: To determine the prevalence of Tubercular cases in clinically diagnosed TB patients and to determine the prevalence of Rifampicin resistance by CBNAAT. Materials and Methods: This prospective observational study involved a total of 107 children from January 2018 to June 2019, fulfilling the inclusion criteria who were clinically diagnosed and found positive in conventional tests for TB. CBNAAT was used to confirm Mycobacterium tuberculosis (MTB) for the diagnosis of childhood TB and compare with other conventional methods. Chi-square test for the proportion was applied and p-value &lt;0.05 taken as significant. Results: Of the 107 patients studied, 44.9% were female and 55.1% were male. The age range was 3 months to 12 years. The cases were confirmed by CBNAAT in clinically suspected case of TB was found to be 17.8% (19 cases out of 107 patients). CBNAAT was able to detect MTB in 14% (15 cases out of 107 patients) of the gastric aspirate/sputum sample. Out of 107 patients, 69 children were clinically diagnosed as Neurotuberculosis and 13% (9 out of 69 cases) cases were confirmed by CBNAAT in Cerebrospinal Fluid (CSF). OF which 29 patients had CSF analysis suggestive of Tubercular Meningitis (TBM). Out of 29 patients, 10 (34.5%) cases were confirmed by CBNAAT. This test showed a significant association with positive Mantoux test (p-value 0.020) and CSF analysis (p-value 0.021) suggestive of TBM. Conclusion: CBNAAT should be used in preference to conventional methods as the initial diagnostic test for patients suspected of having TB. CBNAAT positivity shows significant association with positive Mantoux test and CSF analysis suggestive of TBM.

Is Cartridge Based Nucleic Acid Amplification Test (CBNAAT) Better Than Conventional Tests in Diagnosing Childhood Tuberculosis? Evidence from a Tertiary Care Hospital in Eastern India

Is Cartridge Based Nucleic Acid Amplification Test (CBNAAT) Better Than Conventional Tests in Diagnosing Childhood Tuberculosis? Evidence from a Tertiary Care Hospital in Eastern India

Comparative Performance of Modified Kenneth Jones Criteria Scoring, World Health Organization Criteria, and Antibodies in Lymphocyte Supernatant for Diagnosing Tuberculosis in Severely Malnourished Children Presenting With Pneumonia.

Background: The diagnosis of childhood tuberculosis (TB) can be difficult in severely malnourished children. This is mainly due to the fact of our perceived notion that clinical signs of TB are often subtle in severely malnourished children and we may rely on laboratory investigation for the diagnosis. However, comparative data on the performance of clinical and laboratory diagnostics of TB in such population are also very limited.Objectives: To compare the performance of composite clinical criteria and a technique that measures antibodies in lymphocyte supernatant (ALS) for the diagnosis of TB in severely malnourished children with pneumonia.Methods: Severely malnourished children under five with radiological pneumonia admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh were enrolled consecutively following informed consent. We collected venous blood for ALS, gastric lavage fluid and induced sputum for microscopy, mycobacterial culture, and real-time PCR by Xpert MTB/RIF. We compared the sensitivity, specificity, positive, and negative predictive values, and accuracy of modified Kenneth Jones criteria (MKJC) score, World Health Organization (WHO) criteria, and ALS in diagnosing TB in severely malnourished children with pneumonia for “Confirmed TB” and “All TB” (“Confirmed TB” plus “Probable TB”) vs. “Not TB.”Results: Compared to culture confirmed TB, the sensitivity, and specificity (95% CI) for MKJC were 60 (27–86) and 84 (79–87)% and for WHO criteria were 40 (14–73) and 84 (80–87)%, respectively. Compared to culture and/or Xpert MTB/RIF positive TB, the sensitivity and specificity (95% CI) for the criteria were 37 (20–58) and 84 (79–87)%; and 22 (9–43) and 83 (79–87)%, respectively. For both these comparisons, the sensitivity and specificity of ALS were 50 (14–86) and 60 (53–67)%, respectively.Conclusion: Our data suggest that WHO criteria and MKJC scoring mainly based on clinical criteria are more useful than ALS in diagnosing TB in young severely malnourished children with pneumonia. The results underscore the importance of using clinical criteria for the diagnosis of TB in severely malnourished children that may help to minimize the chance of over treatment with anti-TB in such population, especially in resource limited TB endemic settings.

Laboratory Diagnosis of Childhood Tuberculosis: is Stool an Appropriate Sample?

Laboratory Diagnosis of Childhood Tuberculosis: is Stool an Appropriate Sample?

Análise de casos notificados de tuberculose em crianças e adolescentes

OBJETIVO: Analisar os casos notificados de tuberculose em crianças e adolescentes no estado do Acre no ano de 2017. MÉTODO: Estudo transversal, exploratório, de abordagem quantitativa, com coleta de informações em banco de dados secundários. A população do estudo foi composta de casos de tuberculose entre crianças e adolescentes do estado do Acre- Brasil, registrados no ano de 2017 no Departamento de Informática do SUS - DATASUS. RESULTADOS: Foram notificados 59 casos de tuberculose entre crianças e adolescentes no Acre no ano de 2017, destes 38 (65%) ocorreram no município de Rio Branco. Houve a predominância de notificação de casos no sexo masculino 36 (61%) sendo que a faixa etária mais acometida foi de 15 a 19 anos 41(70%), a forma clínica mais prevalente foi a Tuberculose Pulmonar (50) 85%. Quanto à situação de encerramento dos casos no sistema de informação (38) 64% foram encerrados por cura. CONCLUSÃO: O diagnóstico da tuberculose em crianças e adolescentes é uma realidade no estado do Acre e torna-se de extrema importância a adoção de práticas profissionais que contemplem o diagnóstico e tratamento precoce voltados para essa faixa etária visando a prevenção e controle da doença.

Prevalence and Clinico- Laboratory Profile of Tuberculosis in Children in Nobel Medical College, Biratnagar

Introduction: Tuberculosis infection is very common, and it continues to be the major public health problem in Nepal. Published data about the epidemiology of TB in children is scarce in Nepal, though it is considered one of the most common causes of childhood morbidity in the country. &#x0D; Aims and objectives: To calculate the prevalence of tuberculosis in children aged 0-15 years and to study their clinico-laboratory profile.&#x0D; Methodology: This is a hospital based study conducted in Nobel Medical College Teaching Hospital, Biratnagar over a period of one year. We analyzed 289 children aged 0-15 years suspected of having tuberculosis on clinical grounds and subjected to further screening tests.&#x0D; Results: Majority of the children were males and most of the children were 5-15 years of age. 15 of the cases were diagnosed as tuberculosis out of which one case was bacteriologically confirmed pulmonary tuberculosis and be 5.2 %. Fever and cough were the most common clinical presentations and mantoux test and chest X-ray were most suggestive in majority of the cases.&#x0D; Conclusions: This study supports the use of history and thorough clinical examination and high index of clinical suspicion for diagnosis of childhood tuberculosis.