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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 1  |  Issue : 1  |  Page : 55-58

The Difficulties of Childhood Tuberculosis Diagnosis


Department of Bacteriology, Laboratory of Tuberculosis and Mycobacteria, Pasteur Institute of , Algiers, Algeria

Date of Web Publication24-Jul-2017

Correspondence Address:
Amal Meriem Djouahra
City of brothers Ben Rabah D1 C2 112 building dar el beida, Algiers
Algeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_35_17

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  Abstract 

The children just as adults are exposed to contract and develop the multi-resistant forms of tuberculosis (TB), constituting a major issue for the disease control. The children <5 years of age are the most exposed to present the most serious and more often deadly forms of the illness. Further, in many developing countries, the lack of pediatric forms of the TB drugs makes it difficult to control the problem. The TB diagnosis among the children is based on a set of arguments: the presence of a tuberculous person excreting bacillus, exposition and receptivity conditions of the child (the level of his immunity, the level of undernutrition, and associated pathologies). The diagnosis is also based on the research of the symptoms and other signs suggestive of TB: tuberculin skin test, thoracic radiography, and interferon-gamma test. The aim of this study is to describe and analyze the features and difficulties of the biological diagnosis of TB among the children and to find a strategy for the improvement of the results.

Keywords: Children, diagnosis, multi-resistant, pediatrics, tuberculosis


How to cite this article:
Djouahra AM, Ifticene M, Boulahbal F. The Difficulties of Childhood Tuberculosis Diagnosis. Biomed Biotechnol Res J 2017;1:55-8

How to cite this URL:
Djouahra AM, Ifticene M, Boulahbal F. The Difficulties of Childhood Tuberculosis Diagnosis. Biomed Biotechnol Res J [serial online] 2017 [cited 2022 Aug 16];1:55-8. Available from: https://www.bmbtrj.org/text.asp?2017/1/1/55/211412


  Introduction Top


The diagnosis of the active pulmonary tuberculosis (TB) in the childhood is based on symptoms, radiology, the tuberculin skin test (TST), and rarely on the bacteriological examination of sputum.[1],[2],[3]

The number of child with TB reported by the health structures is considerably higher than the one for whom the laboratory diagnosis is required.[1]

The diagnosis of symptomatic disease of the child is based on clinical symptoms, radiology, and the TST.

The diagnosis of the extrapulmonary TB is based on clinical, radiological, pathological, and rarely on bacteriological examinations (ganglion, pleura, osteoarticular for the most frequents) and the TST.

The child is as likely exposed as the adult to get a multi-drug resistant TB (MDR-TB), in most of TB control programs, children are not considered as infection sources, so they are not a priority, progress have been made on adult TB diagnosis and treatment, while the childhood TB is still underestimated epidemic in most countries.[4],[5]

The TB diagnosis in the child under 5 years of age is difficult; a large number of child with TB are not identified and therefore incorrectly treated.[6]

The difficult for evaluation of the burden of TB in children is based on difficulties on establishing a definitive diagnosis, so the smear tests are often negative which leads to a lower priority for the public health, insufficient, and irregular TB cases reporting by the pediatrician of the public and private sectors to the national TB program (NTP), which gives an under notification of the number of TB cases in the children under treatment.[4],[5],[6],[7],[8]

According to data from the National TB Control Program in Algeria (Ministry of Health), in 2014, 72 cases of children (0.67 cases/100,000 children) under 15 years of age were registered pulmonary TB with positive microscopy (TPM+), in 2015, 63 cases of children (0.59 cases/100,000 children) of <15 years of age were registered TPM+.

The purpose of this study is to assess the place of bacteriological diagnosis in the identification of TB cases and MDR-TB in children

In our context, the number of children with TB reported by health structures is considerably higher than the one for which we received samples for bacteriological diagnosis.


  Methods Top


Retrospective study was carried out over laboratory data and records covering the period 2002–2015, all the child under age 15 samples for whom culture and sensitivity testing have been made and all strains sent by other laboratories for identification and drug susceptibility testing.

A total of 3150 samples of children were collected, of which 2124 are pulmonary samples, and 1026 are samples of extrapulmonary origin.


  Results Top


Of the 2124 cases of children received, only 234 cases of pulmonary TB (11.02%) were confirmed, corresponding to 17 cases per year [Figure 1].
Figure 1: Pulmonary tuberculosis cases among children (from 2002 to 2015)

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Of the 1026 cases of children received, only 53 cases of extrapulmonary TB (5.17%) were confirmed, corresponding to 4 cases per year [Figure 2].
Figure 2: Extra pulmonary tuberculosis cases in children (2002–2015)

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Of the 287 cases of children received, 198 (69%) pulmonary specimens were treated at the laboratory level and 36 (13%) were external crops [Figure 3].
Figure 3: Positive culture on children samples (2002–2015)

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Of the 53 extrapulmonary specimens of children received, 18 (34%) were ganglionic form, followed by pleural form, 11 (21%), followed by others sites; 6% meningeal, 5% osteoarticular, and 4% peritoneal forms [Figure 4].
Figure 4: Percentage of positron emission tomography in children to (2002–2015)

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The percentage of children with pulmonary TB is higher (83.33%) in children (5–15 years), followed by children between 1 and 4 years old, 11.11%, with an average age of 11 years [Figure 5].
Figure 5: The percentage of total percentage depending on age/the percentage of extra pulmonary tuberculosis (PET) depending on

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The percentage of children with extrapulmonary TB is higher (70%) in children (5–15 years), followed by children <1 year old with an average age of 8 years [Figure 5].

Of the 287 cases of TB children, 268 (93.38%) were susceptible and 19 (6.62%) resistant, of which 16 (84%) were MDR [Figure 6].
Figure 6: Susceptibility of strains of children

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Of the 16 MDR children, 10 children have already been treated [Figure 7], whose age is >13 years and 6 have never been treated with an age >8 years. The 3 children never treated and not MDR, are older than 10 years [Figure 8].
Figure 7: Susceptibility of Mycobacterium tuberculosis strains, children already or never treated

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Figure 8: Distribution of children by age, history of treatment and strains susceptibility

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  Discussion Top


About 11.02% of pulmonary TB children out of a total of 2124 were diagnosed between 2002 and 2015 and 5.17% of extrapulmonary TB children out of a total of 1026, were diagnosed between 2002 and 2015, given the number of cases of children declared and treated; the bacteriological diagnosis is far below expectations.

Of the 19 children for whom a TB tested strain, was found to be resistant, 16% or 84% are MDR strains which is a high proportion.

Clinicians' demand for a certainty diagnosis is insufficient; clinicians, radios, and IDRs are often required to start treatment.

Limits of TB diagnostic techniques are the obtaining respiratory secretions children not well spitting, the use of invasive techniques (bronchial aspiration and gastric tubing), paucibacillary samples, low efficiency of bacteriological techniques (low positivity in microscopy and in culture), the inability to make good samples for the bacteriological diagnosis of positron emission tomography and lack or difficult access to the high-performance laboratories.[9],[10]


  Conclusion Top


The childhood TB is often underdiagnosed or difficult to be diagnosed. The under-reporting to the NTP is a result of the nondeclaration of working pediatricians in public and private sectors.[4],[5]

To improve the childhood TB detection, clinicians; must make a bacteriological diagnosis for any children suspected of TB before treatment, must search the contaminator around the immediate entourage of the child especially if children are fewer than 5 years of age and must multiply the samples and available techniques before treatment to implement the diagnosis.[11]

Among recommendations for improving the diagnosis of childhood TB are to conduct a drug-susceptibility test to the anti-TB drugs for children having a positive culture, especially for those who have received drugs and those who are living next to TB patient, to apply new molecular technique as GeneXpert for at least this last category of children, and to support collaboration between clinician and microbiologist for the best diagnostic and treatment results.[11],[12]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chiang SS, Swanson DS, Starke JR. New diagnostics for childhood tuberculosis. Infect Dis Clin North Am 2015;29:477-502.  Back to cited text no. 1
    
2.
Faddoul D. Childhood Tuberculosis: An Overview. Adv Pediatr 2015;62:59-90.  Back to cited text no. 2
    
3.
Hertting O, Shingadia D. Childhood TB: When to think of it and what to do when you do. J Infect 2014;68 Suppl 1:S151-4.  Back to cited text no. 3
    
4.
Marais BJ, Schaaf HS. Childhood tuberculosis: An emerging and previously neglected problem. Infect Dis Clin North Am 2010;24:727-49.  Back to cited text no. 4
    
5.
Marais BJ, Schaaf HS. Childhood tuberculosis: An emerging and previously neglected problem. Infect Dis Clin North Am 2010;24:727-49.  Back to cited text no. 5
    
6.
Tsai KS, Chang HL, Chien ST, Chen KL, Chen KH, Mai MH, et al. Childhood tuberculosis: Epidemiology, diagnosis, treatment, and vaccination. Pediatr Neonatol 2013;54:295-302.  Back to cited text no. 6
    
7.
Ho PK, Shingadia D. Tuberculosis in children. Paediatr Child Health 2017;27:109-15.  Back to cited text no. 7
    
8.
Elmghari M, Zaghba N, Benjelloun H, Yassine N. Clinical, epidemiological and therapeutic profile of tuberculosis in children. Rev Mal Respir 2017;34:245.  Back to cited text no. 8
    
9.
Singh V. Diagnosis of childhood tuberculosis - The road so far and the way ahead. Pediatr Infect Dis 2010;2:119-22.  Back to cited text no. 9
    
10.
Ghanashyam B. Childhood tuberculosis - The time for action is NOW. Pediatr Infect Dis 2012;4:94-5.  Back to cited text no. 10
    
11.
Marais BJ, Pai M. New approaches and emerging technologies in the diagnosis of childhood tuberculosis. Paediatr Respir Rev 2007;8:124-33.  Back to cited text no. 11
    
12.
Delacourt C. Specific features of tuberculosis in childhood. Rev Mal Respir 2011;28:529-41.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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