Exploring non-sputum biosignatures for tuberculosis triage and diagnosis in children living with HIV

Area of Science:

• Biomarker discovery for infectious diseases
• Pediatric infectious disease diagnostics
• Global health challenges in TB management

Background:

• Pediatric tuberculosis (TB), particularly in HIV-co-infected children, presents diagnostic challenges due to ineffective sputum-based methods.
• Difficulties in sample collection and paucibacillary nature of the disease in children necessitate alternative diagnostic strategies.
• Existing diagnostic advancements often exclude high-risk pediatric populations and lack diverse validation.

Purpose of the Study:

• To review recent advancements in non-sputum biosignatures for diagnosing pediatric TB.
• To explore host- and pathogen-based biomarkers in various biological samples.
• To identify barriers and propose solutions for translating TB biosignatures into clinical practice for children.

Main Methods:

• Comprehensive review of current literature on non-sputum biosignatures for pediatric TB.
• Analysis of biomarkers detected in blood, urine, stool, and breath samples.
• Evaluation of challenges in diagnostic test development and implementation.

Main Results:

• Non-sputum biosignatures show promise for early TB detection in children, including those with HIV.
• Significant gaps exist in translating biosignature discoveries into validated, usable diagnostics for pediatric populations.
• Complex laboratory platforms and exclusion of key demographics hinder progress.

Conclusions:

• Non-sputum biosignatures offer a promising avenue for early pediatric TB diagnosis, especially in HIV-co-infected children.
• Validation and translation into affordable, point-of-care tools are crucial for clinical integration.
• Implementation science and adaptation for low-resource settings are essential for real-world impact.