Utility of RNTCP Guidelines in Microbiological Confirmation of Pediatric Tuberculosis

Abstract Background Difficult specimen collection and low bacillary load makes microbiological confirmation of tuberculosis (TB) in children challenging. In this study, we conducted a systematic review and meta-analysis to assess diagnostic accuracy of Xpert on stool for pediatric tuberculosis. Methods Our search included studies from 2011 through 2019 and specific search terms were used to retrieve articles from Pubmed, EMBASE, BIOSIS, Clinical trials.gov and Google scholar. Risk of bias was assessed using QUADAS 2 tool. The protocol was registered in PROSPERO (CRD42018083637). Summary estimates of sensitivity and specificity were conducted using meta-disc Software assuming a random effects model. Results We identified 12 eligible studies which included data from 2177 children, of whom 295 (13.6%) had bacteriologically confirmed TB on respiratory specimens. The pooled sensitivity of xpert MTB/RIF on stool specimens compared to bacteriologically confirmed tuberculosis with respiratory specimens was 0.50 (95%CI 0.44-0.56) with I 2 of 86%, which was statistically significant (p<0.001). The pooled specificity was 0.99 (95% CI 0.98-0.99), I 2 of 0.0%, p=0.44. Conclusions Despite the observed heterogeneity, stool may be considered as an additional specimen to support diagnosis of pulmonary TB in children especially in settings where it is impossible to get respiratory samples. Further studies should evaluate its optimization as a diagnostic tool.

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COMPARISON OF SOCIO-DEMOGRAPHIC AND CLINICAL FACTORS AND TREATMENT OUTCOME OF PULMONARY AND EXTRA PULMONARY PEDIATRIC TUBERCULOSIS

10.26226/morressier.5ad774dfd462b80296ca6b9e ◽

2018 ◽

Author(s):

Emine Kocabas

Keyword(s):

Treatment Outcome ◽

Clinical Factors ◽

Extra Pulmonary ◽

Pediatric Tuberculosis

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Submandibular Lymphadenitis in an Immunocompetent Female: Microbiological Confirmation is Need of the Hour

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666190619150549 ◽

2019 ◽

Vol 19 ◽

Author(s):

Lipika Singhal ◽

Pooja Kumari ◽

Menal Gupta ◽

Kranti Garg ◽

Jagdish Chander

Keyword(s):

Side Effects ◽

Female Patient ◽

Multidrug Resistant ◽

Cervical Lymphadenitis ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Healthy Female ◽

Microbiological Examination ◽

Rising Incidence ◽

Microbiological Confirmation

: Non-tuberculous mycobacterial (NTM) infections have been drawing interest recently because of their rising incidence not only in immunocompromised but also in immunocompetent individuals. These are underdiagnosed in India, due to lack of awareness and a low index of suspicion. In regions endemic for tuberculosis (TB) such as India, presumptive anti-tubercular treatment (ATT) is often prescribed. Non-response of NTM to the treatment may be wrongly ascribed to multidrug-resistant tuberculosis. This emphasizes the need to correctly identify them before initiating therapy. We describe the case of a young, healthy female patient who developed cervical lymphadenitis and was given presumptive ATT. Microbiological examination of aspirate revealed M. fortuitum. This not only rectified the course of treatment resulting in complete cure, but also spared the patient from significant side effects of ATT. This case is an awakening call for clinicians to avoid presumptive ATT.

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Epidemiology, clinical manifestations, and diagnostic challenges of pediatric tuberculosis

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2012.05.159 ◽

2012 ◽

Vol 16 ◽

pp. e64

Author(s):

C. Sreeramareddy ◽

C. Mukhopadhyay ◽

T. Phe ◽

M. Rahman

Keyword(s):

Clinical Manifestations ◽

Pediatric Tuberculosis

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Rifampicin-Resistant Disseminated Tuberculosis in an Immunocompetent Adolescent Male Presenting with Retropharyngeal Abscess and Spinal Involvement

Journal of Laboratory Physicians ◽

10.1055/s-0041-1730754 ◽

2021 ◽

Author(s):

Arghya Das ◽

Vineeta Gupta ◽

Shampa Anupurba

Keyword(s):

Mycobacterium Tuberculosis ◽

Effective Treatment ◽

Spinal Tuberculosis ◽

Clinical Specimen ◽

Retropharyngeal Abscess ◽

Adolescent Male ◽

Irreversible Damage ◽

Disseminated Tuberculosis ◽

Rare Manifestation ◽

Microbiological Confirmation

AbstractRetropharyngeal abscess is a rare manifestation in spinal tuberculosis. Early clinical diagnosis followed by microbiological confirmation and effective treatment is crucial to avoid irreversible damage to the spine. Here, we report a case of disseminated tuberculosis in an immunocompetent adolescent male who presented with retropharyngeal abscess, multifocal involvement of the spine, and skin tuberculids. Xpert MTB/RIF assay in this patient facilitated early lifesaving treatment by detecting rifampicin-resistant Mycobacterium tuberculosis (MTB) in the clinical specimen.

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Developing National Genotype-Independent Indicators for Recent Mycobacterium Tuberculosis Transmission Using Pediatric Cases—United States, 2011-2017

Public Health Reports ◽

10.1177/0033354920985215 ◽

2021 ◽

pp. 003335492098521

Author(s):

Alexia V. Harrist ◽

Clinton J. McDaniel ◽

Jonathan M. Wortham ◽

Sandy P. Althomsons

Keyword(s):

United States ◽

Mycobacterium Tuberculosis ◽

Statistical Model ◽

Moving Average ◽

The United States ◽

Tuberculosis Transmission ◽

Average Proportion ◽

Pediatric Tb ◽

Case Rate ◽

Pediatric Tuberculosis

Introduction Pediatric tuberculosis (TB) cases are sentinel events for Mycobacterium tuberculosis transmission in communities because children, by definition, must have been infected relatively recently. However, these events are not consistently identified by genotype-dependent surveillance alerting methods because many pediatric TB cases are not culture-positive, a prerequisite for genotyping. Methods We developed 3 potential indicators of ongoing TB transmission based on identifying counties in the United States with relatively high pediatric (aged <15 years) TB incidence: (1) a case proportion indicator: an above-average proportion of pediatric TB cases among all TB cases; (2) a case rate indicator: an above-average pediatric TB case rate; and (3) a statistical model indicator: a statistical model based on a significant increase in pediatric TB cases from the previous 8-quarter moving average. Results Of the 249 US counties reporting ≥2 pediatric TB cases during 2009-2017, 240 and 249 counties were identified by the case proportion and case rate indicators, respectively. The statistical model indicator identified 40 counties with a significant increase in the number of pediatric TB cases. We compared results from the 3 indicators with an independently generated list of 91 likely transmission events involving ≥2 pediatric cases (ie, known TB outbreaks or case clusters with reported epidemiologic links). All counties with likely transmission events involving multiple pediatric cases were identified by ≥1 indicator; 23 were identified by all 3 indicators. Practice Implications This retrospective analysis demonstrates the feasibility of using routine TB surveillance data to identify counties where ongoing TB transmission might be occurring, even in the absence of available genotyping data.

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Breath can discriminate tuberculosis from other lower respiratory illness in children

Scientific Reports ◽

10.1038/s41598-021-80970-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Carly A. Bobak ◽

Lili Kang ◽

Lesley Workman ◽

Lindy Bateman ◽

Mohammad S. Khan ◽

...

Keyword(s):

Machine Learning ◽

Lower Respiratory Tract ◽

Cross Validation ◽

Pediatric Patients ◽

Respiratory Illness ◽

Health Crisis ◽

Machine Learning Model ◽

Childhood Tb ◽

Pediatric Tb ◽

Pediatric Tuberculosis

AbstractPediatric tuberculosis (TB) remains a global health crisis. Despite progress, pediatric patients remain difficult to diagnose, with approximately half of all childhood TB patients lacking bacterial confirmation. In this pilot study (n = 31), we identify a 4-compound breathprint and subsequent machine learning model that accurately classifies children with confirmed TB (n = 10) from children with another lower respiratory tract infection (LRTI) (n = 10) with a sensitivity of 80% and specificity of 100% observed across cross validation folds. Importantly, we demonstrate that the breathprint identified an additional nine of eleven patients who had unconfirmed clinical TB and whose symptoms improved while treated for TB. While more work is necessary to validate the utility of using patient breath to diagnose pediatric TB, it shows promise as a triage instrument or paired as part of an aggregate diagnostic scheme.

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