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The possibility of and need for getting definitive diagnosis of tuberculosis in children
Manjula Datta1, M P Radhamani2, Manjula Singh3
1National Institute for Research in Tuberculosis, India; M Viswanathan Diabetes Research Centre, India.
Insights
Investigating pediatric tuberculosis (TB) is feasible in children with suggestive symptoms. Documenting bacteriology in suspected childhood TB cases is achievable and aids epidemiological understanding.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in children.
- Accurate diagnosis in pediatric TB is often difficult due to non-specific symptoms and challenges in sample collection.
Purpose of the Study:
- To assess the feasibility and utility of diagnostic investigations in children presenting with symptoms suggestive of TB.
- To evaluate the effectiveness of bacteriological confirmation in pediatric TB cases.
Main Methods:
- A study involving 2479 children with symptoms suggestive of TB was conducted in Chennai.
- Investigations included detailed history, clinical examination, tuberculin testing, chest X-ray, and sputum/gastric lavage for Mycobacterium tuberculosis (M.TB) culture.
- High coverage (over 90%) was achieved for all investigations.
Main Results:
- Mantoux test positivity was high (64%) but lacked discriminatory power for bacteriological confirmation.
- A significant proportion (61%) of bacteriologically positive children had normal chest X-rays.
- Bacteriological confirmation rates were 2.7% for sputum culture and 6.8% for gastric lavage culture.
Conclusions:
- Documenting bacteriology in children with suspected TB is feasible and recommended for large pediatric TB centers.
- This approach is crucial for accurate case ascertainment and understanding the epidemiology of childhood TB.
- Confirming bacteriology ensures that reported cases are definitively tuberculosis.
Background And Objectives:
A study of tuberculosis in children was undertaken in the outpatient departments of four hospitals in Chennai city by the Tuberculosis Research Centre of the Indian Council for Medical Research. The objective of this partial analysis was to assess the feasibility and usefulness of carrying out investigations in children selected on the basis of symptoms suggestive of TB.
Methods:
2479 Children were admitted to the study based on symptoms like prolonged or irregular cough or fever, with or without systemic signs. Detailed history was taken and clinical examination was carried out in all children presenting to the outpatient departments. All children were tuberculin tested, and had a chest x-ray. Sputum examination or gastric lavage on two consecutive days was examined for M.TB by culture.
Results:
All the investigations could be done with a coverage of over 90 %. Mantoux was positive in 64 % of the patients, but did not help distinguish those who were more likely to be bacteriologically positive. 61 % of the bacteriology positive children had a normal X-ray. Gastric lavage or sputum were obtained in 99 % of patients; 2.7 % for sputum and 6.8 % for gastric lavage were positive on culture.
Conclusions:
The feasibility of documenting the bacteriology in children with suspected TB was good, and should be attempted in all large centers dealing with TB in children. This would also help to understand the epidemiology of TB in children by ensuring that the reported cases are without doubt cases of tuberculosis.
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