New Diagnostics for Childhood Tuberculosis

Chiang, Silvia S.; Swanson, Douglas; Starke, Jeffrey R.

doi:10.1016/j.idc.2015.05.011

Cited by 51 publications

(42 citation statements)

References 112 publications

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“…The limited sensitivity of culture as well as the rapid progression to disease in children necessitates that the decision to initiate treatment for TB is usually made prior to microbiological confirmation. Bacteriologic confirmation of childhood TB disease typically occurs in Ͻ40% of cases (3)(4)(5). However, in areas where TB is highly endemic or in infants, culture positivity rates can be as high as 70%.…”

Section: Culture Detection Methodsmentioning

confidence: 99%

“…Meta-analysis from16 different studies showed that GA and sputum specimens (expectorated and induced) performed comparably, with pooled sensitivities compared with culture of 66% and 62%, respectively (33). Unfortunately, due to the paucibacillary nature of M. tuberculosis disease in children, the rate of culture-negative disease is high with Ͻ40% of clinically suspected cases resulting in culture positivity (3)(4)(5). As such, it is important to note that the clinical sensitivity of Xpert MTB/RIF is quite low.…”

Section: Molecular Detection Methodsmentioning

confidence: 99%

“…The number of organisms involved in this process tends to be small; hence, childhood TB is often called paucibacillary. As a result, finding direct evidence of the organism in body fluids and tissues is difficult, and in most case series, fewer than 40% of childhood TB cases can be microbiologically confirmed (3)(4)(5). In the other Ն60% of cases, the diagnosis is made by the analysis of signs and symptoms, radiography, tests of infection, and epidemiology-knowing that the child has been exposed recently to a case of contagious tuberculosis.…”

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confidence: 99%

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Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children

2016

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Diagnosis of tuberculosis in children is challenging; even with advanced technologies, the diagnosis is often difficult to confirm microbiologically in part due to the paucibacillary nature of the disease. Clinical diagnosis lacks standardization, and traditional and molecular microbiologic methods lack sensitivity, particularly in children. Immunodiagnostic tests may improve sensitivity, but these tests cannot distinguish tuberculosis disease from latent infection and some lack specificity. While molecular tools like Xpert MTB/RIF have advanced our ability to detectMycobacterium tuberculosisand to determine antimicrobial resistance, decades old technologies remain the standard in most locales. Today, the battle against this ancient disease still poses one of the primary diagnostic challenges in pediatric laboratory medicine.

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Section: Culture Detection Methodsmentioning

confidence: 99%

Section: Molecular Detection Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children

2016

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“…The morbidity and mortality implications of so many children not receiving treatment are profound and very worrying. Estimation of how many of these “invisible” children exist has been an essential part of raising advocacy for these children and demonstrating the need for improved diagnostics [25] and methods to find these children (e.g. active case-finding [26]).…”

Section: Incidence Of Childhood Tb Diseasementioning

confidence: 99%

Global burden of childhood tuberculosis

Jenkins

2016

Pneumonia

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In 2015, the World Health Organization (WHO) declared tuberculosis (TB) to be responsible for more deaths than any other single infectious disease. The burden of TB among children has frequently been dismissed as relatively low with resulting deaths contributing very little to global under-five all-cause mortality, although without rigorous estimates of these statistics, the burden of childhood TB was, in reality, unknown. Recent work in the area has resulted in a WHO estimate of 1 million new cases of childhood TB in 2014 resulting in 136,000 deaths. Around 3% of these cases likely have multidrug-resistant TB and at least 40,000 are in HIV-infected children. TB is now thought to be a major or contributory cause of many deaths in children under five years old, despite not being recorded as such, and is likely in the top ten causes of global mortality in this age group. In particular, recent work has shown that TB is an under-lying cause of a substantial proportion of pneumonia deaths in TB-endemic countries. Childhood TB should be given higher priority: we need to identify children at greatest risk of TB disease and death and make more use of tools such as active case-finding and preventive therapy. TB is a preventable and treatable disease from which no child should die.

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“…El diagnóstico en niños se dificulta debido a la naturaleza paucibacilar de la enfermedad y a las limitaciones para recolectar muestras de buena calidad que permitan la confirmación microbiológica 7 . Tradicionalmente se usan métodos invasivos, como aspirado en jugo gástrico o lavado broncoalveolar y, en los últimos años, se ha introducido el esputo inducido (EI) como un método alternativo de recolección de muestra, el cual ha mostrado sensibilidad igual o superior al aspirado gástrico (GA) 8 .…”

Section: Introductionunclassified

Xpert MTB/RIF® como herramienta diagnóstica en una cohorte de niños menores de 15 años con sospecha clínica de tuberculosis pulmonar en un hospital de alta complejidad de Medellín

Muñoz

Moreno

et al. 2017

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Introducción: La tuberculosis (TB) en niños posee limitaciones en la confirmación microbiológica. Por su naturaleza paucibacilar y la dificultad para obtener muestras microbiológicas adecuadas, la positividad de cultivos es baja. En adultos, la prueba Gene Xpert MTB/RIF® ha mostrado utilidad por su buen rendimiento, rapidez de resultados y facilidad en su realización. La Organización Mundial de la Salud (OMS) recomienda el empleo de esta prueba en niños, sin embargo, los datos de esta prueba en nuestro medio son limitados. Objetivo: Estudio de cohorte retrospectivo para describir nuestra experiencia con la prueba Gene Xpert MTB/RIF en menores de 15 años hospitalizados en un centro de alta complejidad con sospecha de TB pulmonar. Método: Se revisaron 116 historias clínicas con resultados disponibles de Xpert MTB/RIF en muestras respiratorias tomadas entre junio de 2012 y diciembre de 2013. Se excluyeron 33 casos. Los 83 pacientes incluidos se clasificaron como: TB confirmada 8 (10%), probable 16 (19%) y descartada 59 (71%) según criterios de la OMS. El análisis estadístico se realizó en SPSS 20 y EpiDat 3.1. Resultados: Xpert MTB/RIF mostró para TB confirmada una sensibilidad del 50%, especificidad 96% y valores predictivos positivos y negativos del 57,14 y 94,7%, respectivamente. Al evaluarla en el total de niños que ameritaron inicio de tratamiento (TB confirmada y probable), la sensibilidad fue del 29% con especificidad del 100%. Xpert MTB/RIF detectó una cepa resistente a rifampicina. Conclusión: Xpert MTB/RIF mostró ser útil para el diagnóstico de TB, con una sensibilidad superior a la baciloscopia. Un resultado positivo puede definir el inicio temprano de tratamiento en casos dudosos, confirma el diagnóstico y permite conocer rápidamente si existe resistencia a rifampicina. Un resultado negativo no descarta el diagnóstico ni debe impedir el inicio del tratamiento si cumple con la sumatoria de los otros criterios recomendados por la OMS.

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New Diagnostics for Childhood Tuberculosis

Cited by 51 publications

References 112 publications

Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children

Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children

Global burden of childhood tuberculosis

Xpert MTB/RIF® como herramienta diagnóstica en una cohorte de niños menores de 15 años con sospecha clínica de tuberculosis pulmonar en un hospital de alta complejidad de Medellín

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