Current Trends in Diagnosis and Management of Pediatric Tuberculosis: A Clinician’s Perspective

Abstract

Tuberculosis in the pediatric age group remains one of the most important diseases causing significant morbidity and mortality. In children, extrapulmonary tuberculosis and disseminated tuberculosis are more common. Because most childhood tuberculosis is oligobacteria, these cases are often difficult to diagnose. Although the Mantoux test is easy to perform, it only detects Mycobacterium tuberculosis infection and does not always indicate active disease. Gastric aspiration is more suitable for microscopic examination than induced sputum in children who cannot spit out multiple sputum and must swallow. Direct microscopy using special stains, such as Zeihl Nielsen stain, is highly specific for diagnosing cases of tuberculosis, especially sputum-positive pulmonary tuberculosis, but is more operator-dependent and less sensitive than modern diagnostic tests such as GeneXpert. GeneXpert can also identify rifampicin-resistant Mycobacterium tuberculosis so that appropriate treatment decisions can be made.