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Published on: February 16, 2020
Paving the Way to Innovative, Child-Friendly Pediatric Diagnostic Methods for Tuberculosis: Introduction of
Olena Diuzheva1, Liudmyla Skoklyuk1, Nina Zherebko1
1PATH, 25B, Shota Rustaveli St., 01033 Kyiv, Ukraine.
Insights
Pediatric tuberculosis diagnosis in Ukraine is improving with the integration of stool testing. This noninvasive method aids in detecting Mycobacterium tuberculosis (MTB) and drug-resistant strains, especially in young children unable to produce sputum.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Diagnosing pediatric tuberculosis (TB) is challenging due to paucibacillary nature and difficulties in obtaining respiratory samples.
- Ukraine faces significant hurdles in effectively diagnosing TB in children.
Purpose of the Study:
- To evaluate the integration of stool testing into routine pediatric TB services for improved diagnostic efficiency.
- To assess the utility of stool samples for detecting Mycobacterium tuberculosis (MTB) and rifampicin resistance in children.
Main Methods:
- A pilot study was conducted in 12 regional TB facilities in Ukraine.
- Stool samples were collected from 168 children with a preliminary TB diagnosis between November 2021 and September 2022.
- Bacteriological analysis was performed on stool and other available samples to confirm MTB and detect drug resistance.
Main Results:
- Mycobacterium tuberculosis (MTB) was confirmed in 37 children, with 18 cases detected in stool samples.
- Stool was the sole positive sample for MTB detection in 7 out of 18 children.
- Rifampicin resistance was identified in 7 children, with 3 cases detected in stool samples.
Conclusions:
- Stool testing is a valuable, noninvasive tool for diagnosing pediatric TB, particularly for young children.
- The successful pilot implementation has led to the nationwide adoption of stool testing in Ukraine's national TB program.
- Early detection of TB and drug-resistant strains through stool analysis enables more effective and safer treatment, saving lives.
Abstract:
Like many countries, Ukraine faces challenges with diagnosing tuberculosis (TB) in children due to the paucibacillary nature of the disease and difficulty obtaining respiratory samples. To improve diagnostic efficiency, stool testing is being integrated into routine pediatric TB services. This started with a pilot introduction at 12 regional TB facilities, where stool was collected for children with a preliminary diagnosis of TB, based on clinical and/or radiological or laboratory findings, in addition to routine testing. For 168 children, a stool test was conducted between November 2021 and September 2022, with samples submitted in all 12 pilot regions. For 132 children, other samples were available in addition to stool. Mycobacterium tuberculosis (MTB) was bacteriologically confirmed in 37 children (in stool for 18 children). For 7 of the 18 children with MTB in stool, stool was the only sample in which MTB was detected. Rifampicin resistance was detected in seven children (in stool for three). This noninvasive TB diagnostic sample is especially beneficial for young children who cannot produce sputum. Early detection of TB and its drug-resistant strains in children will allow medical workers to provide safer and more effective treatment and save more lives. Based on the pilot implementation, Ukraine's national TB program began implementing stool testing throughout the country.
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