Diagnosis of pediatric pulmonary tuberculosis with special reference to polymerase chain reaction based nucleic acid amplification test.

Abstract

OBJECTIVE:

To determine the utility of polymerase chain reaction (PCR) for diagnosing pediatric pulmonary tuberculosis (PPTB).

METHOD:

A prospective cross-sectional study was carried out on 100 children less than 14 years of age, with strong clinical suspicion and radiological evidence suggestive of pulmonary tuberculosis (TB). Sputum samples/gastric lavage were collected. Direct smears and culture on Lowenstein Jensen (LJ) media were performed. DNA extraction and amplification was performed using Genei™ Amplification Reagent set for Mycobacterium tuberculosis (MTB) (by Genei, Bangalore, India). This test is based on the principle of single-tube nested PCR which amplifies the repetitive insertion sequence IS6110.

RESULTS:

When compared with culture, sensitivity and specificity of PCR was 93.55% and 92.75%, respectively. The PPV was 85.29% and the NPV was 96.97%. When intention to treat (ITT) was used as the standard, sensitivity, specificity, PPV and NPV of PCR was 47.88%, 93.1%, 94.4%, and 42.19%, respectively, and that of culture was 40.85%, 100%, 100% and 40.85%, respectively. Against response to treatment (RTT), PCR demonstrated sensitivity, specificity, PPV and NPV of 50.9%, 93.1%, 93.33% and 50%, respectively, and for culture it was 43.64%, 100%, 100% and 48.33%, respectively.

CONCLUSION/RECOMMENDATION:

The present study reinforces better case detection rate with PCR-based nucleic acid amplification test as compared with microscopy and culture in pediatric pulmonary TB. PCR showed a higher correlation with clinical diagnosis as compared with microscopy and solid culture. Hence, a molecular platform should be the test of choice for detecting PPTB.

• Authors: Shreshtha Tiwari, Gita Nataraj, Swapna Kanade, Preeti Mehta
• Journal: International journal of mycobacteriology (Int J Mycobacteriol) Vol. 4 Issue 1 Pg. 48-53 (Mar 2015) ISSN: 2212-554X [Electronic] India
• PMID: 26655198 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

Topics

• Adolescent
• Child
• Child, Preschool
• Cross-Sectional Studies
• Female
• Gastric Lavage
• Humans
• Infant
• Infant, Newborn
• Male
• Mycobacterium tuberculosis (genetics)
• Polymerase Chain Reaction (methods)
• Prospective Studies
• Sensitivity and Specificity
• Sputum (microbiology)
• Tuberculosis, Pulmonary (diagnosis, microbiology)