How can we bridge the gap and increase the tuberculosis detection rate in pediatric age group.
Yes you are right sputum is not easily available in children as they are mostly unable to expectorate. And positivity rate of gastric aspirate is also low.
Yes its really challenging to diagnose tuberculosis in Pediatric age group. Pre-existing literature illustrate both the diagnostic difficulty in children and the health system’s need for new, cost-effective diagnostic methods that have been validated for the pediatric population.
Diagnostic techniques classically used in adults have low sensitivity and specificity in children and confirmation by bacteriological identification is not always possible. Thus, treatment often begins in the absence of isolation of the mycobacteria and is based only on the following three factors:
Malangori Parande you are absolutely right but many a times these three methods also seem inefficient and we are in fix, what next? And many a times history of Koch's contact is not there. So mostly we are left with our clinical judgement.
It is really not easy making a diagnosis of tuberculosis in children. Most times we use gastric wash out collected very early in the morning before the child start to eat. That is not easy, so in my place here in Sierra Leone we put the children suspect on trial without testing.
Kamara ji you are right that it's a difficult scenario but it's not valid in the era of evidence based medicine to put on trial without full fledged investigation. But yes at the end of the day clinical decisions do matter.
In the paediatric age group, one needs a high index of suspicion. Here in the tropics, diagnosis is almost entirely based on clinical judgement as laboratory yields are low.
Clinical trials without evidence may breed drug resistance but has been the saving grace for some children in resource poor settings in which we practise.
Yetunde Olasinde you are very right in pointing out that we need a high index of suspicion and lab yeilds are low. We in pediatrics really need a better high yeild tests.
Difficulty in getting the appropriate sample for assay (Gene Xpert). Diagnosis of Childhood tuberculosis hinges on clinical acumen aided by Chest X-ray and x-ray spine (when it's involved).
Surajudeen Bello sir you are right. Thanks for sharing your valuable thoughts on the topic.
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