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Published on: August 16, 2021
Utility of RNTCP (NTEP) guidelines in microbiological confirmation of pediatric tuberculosis
C K Indumathi1, Saurav Jain1, Savita Krishnamurthy1
1Department of Pediatrics, St John's Medical College Hospital, Bengaluru, Karnataka, India.
Insights
Microbiological confirmation of tuberculosis in children is achievable in nearly half of cases using RNTCP guidelines. Diagnostic methods like CB NAAT improve confirmation rates, regardless of age or TB type.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Public health
Background:
- Tuberculosis (TB) diagnosis in children is challenging due to paucibacillary nature.
- RNTCP guidelines are used for TB diagnosis in children.
- Microbiological confirmation is crucial for effective treatment.
Purpose of the Study:
- To determine the proportion of microbiologically confirmed TB in children diagnosed under RNTCP guidelines.
- To evaluate the effectiveness of diagnostic tests for pediatric TB.
Main Methods:
- Retrospective chart review of 151 children diagnosed with TB (December 2016 - June 2020).
- Data collected on Acid Fast Bacillus (AFB) smear and Cartridge Based Nucleic Acid Amplification Test (CB NAAT) results.
- Analysis of confirmation rates by age and TB type (pulmonary vs. extrapulmonary).
Main Results:
- 66 out of 151 children (44%) had microbiologically confirmed TB.
- Confirmation rates were similar across age groups (<5 vs. >5 years) and TB types (pulmonary vs. extrapulmonary).
- CB NAAT showed a statistically significant 10% higher confirmation rate than AFB smear (p=0.000).
Conclusions:
- Microbiological confirmation is feasible in nearly half of pediatric TB cases using RNTCP guidelines.
- Age and TB type do not significantly hinder bacteriologic confirmation.
- CB NAAT is a superior diagnostic tool for pediatric TB compared to AFB smear.
Objective:
To estimate the proportion of microbiologically confirmed disease among children diagnosed with tuberculosis using RNTCP guidelines.
Materials And Methods:
Retrospective chart review of a cohort of 151 children (aged between 1 month and 18 years) diagnosed with Tuberculosis between December 2016 and June 2020 at a pediatric department of a tertiary care hospital. We collected information on AFB (Acid Fast Bacillus) smear and Cartridge Based Nucleic Acid Amplification Test (CB NAAT) results.
Results:
Out of 151 children with a diagnosis of Tuberculosis, 66 (44%) children were found to have microbiologically confirmed disease. Confirmatory rate was almost equal in children less than <5 and >5 years (48% vs 52%). Confirmatory rate did not differ between pulmonary and extra pulmonary samples (49% and 53%). Cartridge Based Nucleic Acid Amplification Test outperformed AFB by 10%, which was statistically significant (p = .000 by fisher exact test).
Conclusion:
Although considered paucibacillary in nature, microbiological confirmation can be obtained in almost up to half of children with a diagnosis of TB by using RNTCP guidelines. Neither young age nor type of TB is a deterrent to bacteriologically confirm TB in children.
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