Original Article ert MTB/RIF in pediatric tuberculosis.

ert MTB/RIF in pediatric tuberculosis.

Abstract

Objective

To study the usefulness of Xpert TB/Rif in diagnosis of childhood tuberculosis in India.

 Methods 

Prospective study was including children from 1 month to 18 years of age with clinical suspicion of tuberculosis. All cases were classified as pulmonary and extra pulmonary tuberculosis based on symptoms. All children under 5 years of age underwent mantoux test. Imaging was done based on symptoms. Appropriate specimens were tested for smear microscopy, Xpert MTB/RIF, and liquid culture.

Results

In cases with a clinical diagnosis, microscopy had a sensitivity of 37.3% (CI-17.2% to 59.3%) and specificity of 100% (71.5%-100%), Xpert MTB/RIF had a sensitivity of 75% (CI- 55.1% to 89.3%) and a specificity of 100% (CI- 75.2% to 100%) while MGIT had a sensitivity of 68.2 % (CI- 51.9% to 81.8%) and specificity of 100% (CI- 75.2% to 100%).

In culture positive cases of pulmonary TB, microscopy had a sensitivity of 42.2% (CI-17.6% to 71.1%)and specificity of 75.0% (CI-34.8% to 96.8%) while Xpert MTB/RIF had a sensitivity and specificity of 78.5% (CI-49.2 to 95.3%) and 47.6% (CI-21.2%-73.4%) respectively. Xpert MTB/RIF had 100% sensitivity for detection of rifampicin resistance. Resistance to moxifloxacin was noted in 78% (11/14) while ofloxacin was resistant in 50% of the isolates (7/14).

Conclusions

With the availability of sensitive tests like Xpert MTB/RIF, paucibacillary disease in children can no longer be an excuse to start empiric anti tubercular drugs. With high levels of resistance for first and second line drugs Xpert MTB/RIF may not yet replace traditional cultures and drug sensitivity.