BackgroundThe enteric string test can be used to obtain a specimen for microbiological confirmation of tuberculosis in children, but it is not widely used for this. The aim of this analysis to evaluate this approach in children with tuberculosis symptoms.MethodsWe conducted a cross-sectional study to assess children’s ability to complete the test (feasibility), and self-reported pain (tolerability). We examined caregivers’ and children’s willingness to repeat the procedure (acceptability) and described the diagnostic yield of cultures for diagnostic tools. We stratified estimates by age and compared metrics to those derived for gastric aspirate (GA).ResultsAmong 148 children who attempted the string test, 34% successfully swallowed the capsule. Feasibility was higher among children aged 11–14 than in children 4–10 years (83% vs 22% respectively, p < 0.0001). The string test was better tolerated than GA in both age groups; however, guardians and older children reported higher rates of willingness to repeat GA than the string test (86% vs. 58% in children; 100% vs. 83% in guardians). In 9 children with a positive sputum culture, 6 had a positive string culture. The one children with a positive gastric aspirate culture also had a positive string culture.ConclusionAlthough the string test was generally tolerable and accepted by children and caregivers; feasibility in young children was low. Reducing the capsule size may improve test success rates in younger children.
OBJECTIVE: To evaluate the performance of a survey that quantifies the intensity of household tuberculosis (TB) exposure among children.METHODS: Children aged 0–14 years in Lima, Peru, with ≥1 signs and/or symptoms of TB and a history of contact with an adult
TB patient were included. The 10-question survey was administered to caregivers and addressed sleep proximity, frequency of exposure, and infectiousness of the contact. Infection status was determined using tuberculin skin tests (TSTs). The exposure scale was evaluated for association with
TST positivity using mixed-effects regression analyses.RESULTS: The exposure score was significantly associated with TST positivity (age-adjusted odds ratio [aOR] 1.14, 95%CI 1.02–1.28). We observed a stronger association with TST positivity in children aged ≤5 years; (aOR
1.23, 95%CI 1.07–1.41) and no association in children 6–14 years of age (aOR 0.99, 95%CI 0.82–1.20).CONCLUSION: This survey was easy to use and modestly successful in predicting TST positivity in children aged ≤5 years. It may be a useful resource for clinicians
for diagnosing TB in children, and for national TB programs aiming to scale up preventive therapy initiatives.
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