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Challenges in diagnosing tuberculosis in children: a comparative study from Sudan
Mogahid M Elhassan1, Miskelyemen A Elmekki1, Ahmed L Osman2
1Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, PO Box 344, Al Madenah Al Monawarah, Saudi Arabia; Department of Medical Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Sudan.
Insights
Diagnosing childhood tuberculosis (TB) in Sudan is difficult. While the tuberculin skin test (TST) and IS6110 PCR showed 100% sensitivity for TB, TST is recommended for routine use, with PCR for urgent cases.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Diagnostic methods
Background:
- Childhood tuberculosis (TB) diagnosis is hampered by limited specimen availability and low bacterial loads.
- Effective diagnostic strategies are crucial for timely treatment and improved outcomes in pediatric TB cases.
Purpose of the Study:
- To evaluate and compare various diagnostic methods for tuberculosis in children in Sudan.
- To determine the sensitivity and specificity of different diagnostic techniques against a reference standard.
Main Methods:
- A cohort of 197 pediatric patients underwent tuberculin skin testing (TST).
- Gastric lavage or sputum specimens were collected, processed, and cultured using Löwenstein-Jensen medium.
- Diagnostic performance of TST, Ziehl-Neelsen stain, auramine stain, and IS6110 PCR was assessed.
Main Results:
- Culture yielded positive results in 16.2% of specimens.
- TST demonstrated 100% sensitivity and 67.3% specificity.
- Ziehl-Neelsen and auramine stains showed lower sensitivity (43.8% and 56.3%, respectively) but high specificity (98.8%).
- IS6110 PCR achieved 100% sensitivity and 98.8% specificity.
Conclusions:
- Both TST and IS6110 PCR offer 100% sensitivity for pediatric TB diagnosis, with IS6110 PCR being more specific.
- TST is recommended for routine diagnosis due to its accessibility.
- PCR is suggested for specific, urgent cases where advanced facilities are available.
Objectives:
The diagnosis of tuberculosis (TB) in children is challenging due to insufficient specimen material and the scarcity of bacilli in specimens. This study aimed to evaluate methods for diagnosing TB in children in Sudan.
Methods:
Patients (N=197) were subjected to the tuberculin skin test (TST). Gastric lavage or sputum specimens were then collected, processed, and cultured as per standard procedures.
Results:
Culture on Löwenstein-Jensen medium, the reference standard, revealed growth in 16.2% of the specimens. Comparative analysis showed that 43.7% were positive for the TST (sensitivity 100%, specificity 67.3%), 8.1% were positive by Ziehl-Neelsen stain (sensitivity 43.8%, specificity 98.8%), 11.2% by auramine stain (sensitivity 56.3%, specificity 98.8%), and 17.8% were positive for PCR amplification of the IS6110 sequence (sensitivity 100%, specificity 98.8%).
Conclusions:
It is concluded that whilst TST and IS6110 achieved 100% sensitivity based on the reference standard of culture, the latter was more specific. The TST is recommended for routine diagnosis and the use of PCR for particular cases, depending on the facilities and the urgency.