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How to optimize current (available) diagnostic tests.

Yeshwant Krishna Amdekar1

  • 1B.J.Wadia Hospital for Children, Jaslok Hospital and Research Center, 151, Tushar, 14th Road, Chembur, Mumbai, 400 071, India. ykasya@gmail.com

Indian Journal of Pediatrics
|November 9, 2010
PubMed
Summary

Diagnosing childhood tuberculosis is challenging due to low bacterial counts. Optimizing current tests like the tuberculin skin test and gastric aspirate cultures, alongside clinical suspicion, is key for accurate diagnosis.

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Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Microbiology

Background:

  • Childhood tuberculosis diagnosis is difficult due to the paucibacillary nature of the disease and sample collection challenges.
  • Current diagnostic methods, including mycobacterium tuberculosis isolation, tuberculin tests, and chest radiographs, have limitations in sensitivity and specificity.
  • New diagnostic tests are emerging but often lack sufficient validation for pediatric use.

Purpose of the Study:

  • To review and optimize the use of current diagnostic tests for childhood tuberculosis.
  • To provide guidance on interpreting diagnostic findings in the context of clinical suspicion.
  • To evaluate the utility of various diagnostic modalities in pediatric tuberculosis.

Main Methods:

  • Review of existing diagnostic protocols and literature for childhood tuberculosis.
  • Emphasis on clinical suspicion guided by Indian Academy of Pediatrics (IAP) protocols.
  • Discussion of conventional tests: Tuberculin Skin Test (TST), chest radiography, and bacteriological examinations (gastric aspirate, bronchoalveolar lavage).

Main Results:

  • Tuberculin Skin Test remains a useful screening tool for infection, requiring careful technique and interpretation.
  • Chest radiography findings like miliary shadows and fibrocaseous cavitary lesions are highly suggestive in endemic areas.
  • Gastric aspirate for smear and culture is the most practical bacteriological method, with improved yield in extensive disease and with expertise.

Conclusions:

  • Optimizing current diagnostic tests and clinical suspicion is crucial for accurate childhood tuberculosis diagnosis.
  • Bacteriological examination, particularly gastric aspirate, should be attempted in all suspected cases.
  • Newer tests like PCR and Interferon Gamma Release Assays (IGRAs) are not routinely recommended due to availability, cost, or insufficient pediatric data; expert consultation is advised for complex cases.