Diagnosis of pediatric pulmonary tuberculosis with special reference to polymerase chain reaction based nucleic acid...

Area of Science:

• Medical Diagnostics
• Microbiology
• Pediatric Infectious Diseases

Background:

• Pediatric pulmonary tuberculosis (PPTB) diagnosis presents challenges due to paucibacillary nature and sample collection difficulties.
• Traditional diagnostic methods like microscopy and culture have limitations in sensitivity and specificity for PPTB.

Purpose of the Study:

• To evaluate the diagnostic utility and accuracy of polymerase chain reaction (PCR) for identifying pediatric pulmonary tuberculosis (PPTB).
• To compare the performance of PCR against conventional methods (microscopy and culture) and clinical assessment in pediatric TB diagnosis.

Main Methods:

• A prospective cross-sectional study involving 100 children under 14 years with suspected PPTB.
• Collection of sputum or gastric lavage samples for direct smear, Lowenstein Jensen (LJ) culture, and single-tube nested PCR targeting the IS6110 sequence of Mycobacterium tuberculosis (MTB).

Main Results:

• PCR demonstrated high sensitivity (93.55%) and specificity (92.75%) when compared to culture.
• PCR showed a higher correlation with clinical diagnosis and treatment response compared to microscopy and culture.
• Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for PCR were 85.29% and 96.97% respectively, against culture.

Conclusions:

• PCR-based nucleic acid amplification tests offer an improved case detection rate for PPTB over microscopy and culture.
• Molecular platforms like PCR are recommended as the preferred diagnostic test for pediatric pulmonary tuberculosis.
• PCR's superior correlation with clinical diagnosis underscores its value in managing pediatric TB cases.