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Pediatrics Conference 2018 Journal of Pediatric Care
ISSN: 2471-805X Page 44
March 26-27, 2018
Edinburgh, Scotland
2 nd Edition of International Congress on
Pediatrics
Childhood tuberculosis is an important public health problem in
resource constrained settings, but continues to be neglected
by physicians and policy makers. Diagnosis is particularly
challenging in infants and children for many reasons. Children
generally donot produce or expectorate sputum, making it difficult
to obtain appropriate samples for analysis. Families generally
do not collect and transport respiratory specimens properly.
The disease is generally paucibacillary and mycobacteria are
shed intermittently, reducing the yield (compared to adults). The
hallmark radiological signs (such as pulmonary cavity) are rarely
seen in childhood tuberculosis. Further physicians often treat
children without confirming the diagnosis. The twin burdens of
HIV infection and rising resistance among mycobacteria add
further challenges to diagnosis. The mainstay of tuberculosis
diagnosis rests on demonstration of acid fast bacilli (AFB) in
biological samples (induced sputum, gastric aspirate/lavage,
nasopharyngeal aspirate, lymph node aspirate, etc.). However
staining with conventional methods yields results in only about
30%confirmedcases.Mycobacterialcultureyieldisalsoextremely
low, but is somewhat improved by using liquid culture media.
Clinical scoring systems have poor sensitivity and specificity; with
limited diagnostic validity for treatment decisions. Radiological
diagnosis rests on demonstration of one of three signs viz. hilar/
paratracheal lymphadenopathy, military shadows and a fibro-
cavitary lesion, but these findings are rare. Tuberculin test and
serological assays are two frequently misused tests. The former
cannot distinguish infection fromdisease (hence has limited value
in endemic settings) and the latter is unreliable and is discouraged
by national and international guidelines. Even interferon gamma
release assays (IGRA) have no value in endemic settings. Recent
molecular diagnostic tests have raised hopes of better diagnostic
platforms. The Xpert MTB RIF system (GeneXpert) is the most
promising among these. A series of systematic reviews shows
that GeneXpert is superior to microscopy, but inferior to culture
(sensitivity ~60%, specificity >95%). This is a setback because
although a positive test result is helpful to start treatment, a
negative test does not rule out tuberculosis. Further, GeneXpert
sensitivity is considerably lower in smear microscopy negative
cases (compared to smear positive cases). However, a significant
advantage is the rapid identification of rifampicin resistance.
Other diagnostic techniques undergoing evaluation in children
include: loop-mediated isothermal amplification (LAMP), and LED
microscopy. However, children are excluded from the majority
of global research studies on newer diagnostic platforms. In
summary, diagnosis of childhood tuberculosis is difficult, and
needs considerable time and effort. A step-wise approach can
increase diagnostic confirmation in this difficult public health
problem.
Diagnosis of tuberculosis in children: challenges and
opportunities
Joseph L Mathew
Postgraduate Institute of Medical Education and Research, India
J Pediatr Care, Volume 4
DOI: 10.21767/2471-805X-C1-006