In 2017, TB was one of the top 10 causes of death globally;an estimated 10.4 millionTB cases were detected of which1 million were children. India (23%) and Indonesia (10%) alone account for a third of the world’s burden.(WHO)
Diagnosis of T.B. in children is challenging due to vague clinical manifestations and difficulty in isolating M.Tb.Microscopy using Ziehl nelson stain, is still used as a diagnostic tool;though cheap and easy to use, poor sensitivity remains a major drawback of this method.Culture in liquid media is the gold standard for bacteriological confirmation of TB.Chest X Ray and other imaging tools such as USG, CT scan& MRI scan aid in the diagnosisespecially where obtaining clinical specimen and bacteriological confirmation maybe difficult.Molecular methods such as polymerase chain reactions (PCRs) allow direct identification of M.Tb in clinical specimens.Molecular LPAs allow rapid detection of resistance to rifampicin (alone or in combinationwith isoniazid).
As per latest WHO guidelines, CBNAAT- Xpert MTB/RIF should be used as the initial diagnostic test. Our studies substantiate this recommendation.
However, even in the presence of all these tests, clinical judgement remains supreme.
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
Mid City Hospital, 3-A Shadman II
Jail Road, Lahore ,Pakistan